Get Sc Dhec 1103v 2017-2025
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How to fill out the SC DHEC 1103V online
The SC DHEC 1103V form is an essential document for documenting immunization services in compliance with federal law. This guide provides a clear and supportive approach to completing the form online, ensuring all required information is accurately recorded.
Follow the steps to fill out the SC DHEC 1103V online.
- Click the ‘Get Form’ button to obtain the form and open it in the editor.
- Begin by entering the patient’s name, date of birth, and identification number at the top of the form.
- For each vaccine administered, record the date given, the injection site, the vaccine manufacturer, the lot or control number, and the date the Vaccine Information Statement (VIS) was given.
- Indicate the administration route for each vaccine by circling the appropriate abbreviation: IM for intramuscular, SC for subcutaneous, PO for oral, and IN for intranasal.
- If applicable, circle the appropriate type of DTaP/DT vaccine given.
- The provider administering the vaccines should sign the Provider ID space and include their initials; for future visits, they only need to record their initials in the Provider ID column.
- Select the appropriate eligibility status from the Eligibility Status Table and record the corresponding letter for each vaccine given.
- If the child has a reliable history of Chickenpox, check the 'yes' box and document the date the box was checked.
- In the Allergies/Comments section, record any known allergies and additional comments if necessary.
- Provide the name and address of the medical practice where the vaccinations are administered.
- Finally, ensure all information is correct, save the completed form online, and retain it in the patient’s medical record.
Complete your immunization documentation online now to ensure accurate record-keeping.
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