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CDC Supplemental COVID-19 Vaccine Redistribution …

WebThe parties to this agreement are CDC and healthcare organizations, third-party vendors, and vaccination providers that redistribute COVID-19 vaccine. CDC cannot reimburse …

Actived: 4 days ago

URL: https://forms.health.pa.gov/CDC-COVID-19-Vaccine-Redistribution/

eVitals Facility Registration Form · Starter Portal

WebFacility Information. Facility name as currently displayed in DAVE/EDRS. Facility's Licensed Name. Doing Business As (DBA) Facility Name. How facility name should be displayed …

Category:  Health Go Health

Authorization For Release Of Immunization Records

WebI hereby authorize the Pennsylvania Department of Health to release information/records in its Pennsylvania Immunization Electronic Registry System (PIERS) files relating to …

Category:  Health Go Health

Immunization Materials · Starter Portal

WebPlease direct questions specific to PA Immunization Materials ordering to: [email protected]. Full Name. Organization. Address Line One. Address Line …

Category:  Health Go Health

CDC COVID-19 Vaccination Program Provider Agreement A and B

WebPlease complete Sections A and B of this form as follows: The Centers for Disease Control and Prevention (CDC) greatly appreciates your organization’s (Organization) …

Category:  Health Go Health

Home · Starter Portal

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Category:  Health Go Health

Environmental Health Concern Form · Starter Portal

WebEnvironmental Health Concern Form. The Division of Environmental Health Epidemiology can assist with relevant environmental health concerns. Please provide your name and …

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Speaking Request Form · Starter Portal

WebThe Pennsylvania Department of Health (DOH) is in receipt of your request for a representative of the Department to participate in your conference/meeting. Please note …

Category:  Health Go Health

Contact Us Form · Starter Portal

WebContact Us Form. Please provide your contact information. Required fields are marked with an asterisk (*). Select the most appropriate category for your inquiry from the list below: …

Category:  Health Go Health

VFC Program Policies and Guidelines Acknowledgment Form

WebThe following is a list of Pennsylvania’s immunization policies and guidelines. Read each policy and acknowledge you’ve read and understood each policy by placing a check …

Category:  Health Go Health

Project Firstline Training Request · Starter Portal

WebPennsylvania Project Firstline (PA PFL) Training Request Form. Please complete all the fields below to indicate the type of training that your facility is seeking from PA PFL. …

Category:  Health Go Health

Contact Us · Starter Portal

WebPersonal or Professional use/inquiry * Organization (if professional use) * I would like to: *

Category:  Health Go Health

C. Auris Poster Order Form · Starter Portal

WebC. Auris Poster Order Form. E-mail. Name. Professional Role. *. Phone Number. Name of PA Healthcare Facility Requesting materials. Shipping Address. Type of PA Healthcare …

Category:  Health Go Health

Act 96 Customer Form · Starter Portal

WebAct 96 of 2018 Temporary Exemption Form. Act 96 – Electronic Prescribing. Do you prescribe controlled substances *

Category:  Health Go Health

Feedback Form · Starter Portal

WebPlease share your email address if you'd like someone to reach out and discuss your comments. **. Generate a new image.

Category:  Health Go Health

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