Check box if there is more than one clinic site Total - Public Health - public health oregon 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the name of your Delegate Agency in the designated field. This ensures that your organization is properly identified.
3. Next, input the Oregon Immunization Program (OIP) Provider Identification Number (PIN) in the corresponding section. This number is crucial for tracking and compliance.
4. Locate the checkbox labeled 'Check box if there is more than one clinic site.' If applicable, click this box to indicate multiple sites.
5. In the field provided, enter the total number of clinic sites associated with your agency. This information helps streamline communication and coordination.
6. Complete any additional required fields, including signatures from authorized personnel and dates, ensuring all necessary approvals are documented.

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