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.

Download this pdf file. Letter from DPH to Pharmacist regarding Vaccine records and process

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FORMS

Download this pdf file. Vaccine Protocol Agreement General Information and Checklist

Download this pdf file. Vaccine Protocol Agreement Form WITH Alternate Physician

Download this pdf file. Vaccine Protocol Agreement Form WITHOUT Alternate Physician

Download this pdf file. Vaccine Protocol Agreement Affidavit

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If you have any questions regarding the process, contact:

Contact

Licensure Specialist Britni Norwood

Contact for Pain Clinics, Acupuncture, and Vaccine Protocols