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Vaccine inventory log sheet

Vaccine inventory log sheet 2025

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The document is the Illinois VFC Pediatric Vaccine Order, Inventory & Accountability Form, used by healthcare practices to report vaccine inventory, request doses, and track administration for pediatric vaccines. It includes sections for practice information, vaccine details (including lot numbers and expiration dates), doses on hand, wasted or expired vaccines, and a record of doses administered by age group.

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Click ‘Get Form’ to open the vaccine inventory log sheet in the editor.
Begin by entering the date at the top of the form. This is crucial for tracking your inventory over time.
Fill in your Practice Name, Phone, and Fax number. Accurate contact information ensures smooth communication regarding orders.
Specify the report period start and end dates. This helps in maintaining a clear record of vaccine usage during that timeframe.
Input the Vaccine Delivery Street Address, City, and ZIP code to ensure proper delivery of vaccines.
Indicate your facility's email address for any correspondence related to your inventory.
Complete the sections for each vaccine type by entering doses on hand, lot numbers, expiration dates, and any wasted/expired doses.
Finally, sign off on the form by entering your name and obtaining a physician's signature to validate the document.

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What must be included on a vaccine inventory log?

Photocopies of immunization records from a licensed healthcare provider or clinic, or from a California K-12 school uploaded to My Health Portal. All records must show the vaccine type, dose, and date of each shot.

What information is required on an immunization record?

Immunization providers are required by law to record what vaccine was given, the date the vaccine was given (month, day, year), the name of the manufacturer of the vaccine, the lot number, the signature and title of the person who gave the vaccine, and the address where the vaccine was given.

What must be included in a vaccine inventory log?

Maintain a vaccine inventory log, which should include vaccine name, number of doses, arrival condition of the vaccine, manufacturer and lot numbers, and expiration date. If the shipment includes lyophilized (freeze-dried) vaccines, ensure they came with the correct type and quantity of diluents.

What information should a vaccine stock sheet record?

Providers usually count only those vaccine doses that are documented in a written record or a state or local online immuni zation information system (known as an IIS, or registry). No national registry maintains this information.