This form is to be used by participating Vaccines for Children (VFC) and 317 Program Providers to have your office information updated in the New Jersey Inventory Management, Order and …
Health Department Forms
IMM-48: Vaccines for Children Program Request to Update Provider Information (Updated April, 2016)
Health Department Forms
Use PDF (NEW!) for electronic AND hand-written completion. Word version contains instructions. (Contact Child & Adolescent Health Program at 609-292-5666 for more information.) …
Form IMM-48 - Fill Out, Sign Online and Download
Fill Out The Vaccines For Children Program Request To Update Provider Information - New Jersey Online And Print It Out For Free. Form Imm-48 Is Often Used In Vaccines For Children …
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you submit the IMM-48 form, ensure that all newly appointed vaccine coordinators have completed the required trainings for the New Jersey Immunization Information System (NJIIS) …
To make changes to site information (Vaccine Coordinators, CEO, CMO, etc.), please submit an electronic IMM-48 form by logging into NJIIS, click on COVID from the left navigation bar, and …
IMM form: 3 copies: 1) signed original for patient on admission; 2) follow-up signed notice to be given to patient prior to discharge; 3) hospital copy. Additional copies may be needed if the …
please fill out the attached IMM-48 Update to Provider Information form and email it to
Downloading and Printing Immigration Forms - USCIS
2023年10月18日 · We provide free fillable forms through our website in PDF format, which means you can type your answers directly on the form instead of printing a blank form and writing …
Currently, at or about the time of admission, hospitals must deliver the “Important Message from Medicare” (IM), as required by Section 1866(a)(1)(M) of the Social Security Act (the Act), to all …