Vaccine Protocol Registration

GCMB has been designated caretaker for the Vaccine Protocol Agreement process. Please find below the application material to submit for Vaccine Protocol Agreement registration.

Letter from DPH to Pharmacist regarding Vaccine records and process

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FORMS

• General Information and Checklist
• Vaccine Protocol Agreement Form WITH Alternate Physician
• Vaccine Protocol Agreement Form WITHOUT Alternate Physician
• Vaccine Protocol Agreement Affidavit

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If you have any questions regarding the process, contact us on NextRequest: GCMB Requests Portal NextRequest - Modern FOIA & Public Records Request Software