To submit the Pediatric Vaccine Order Form, you can either fax it to 573.526.5220 or send it by mail to 930 Wildwood Drive, Jefferson City, MO 65109. Ensure all fields are correctly filled out before submission to avoid delays. For electronic submissions, check if your organization allows emailing the completed form, and send it to the appropriate contact. Our advice is to double-check all information and ensure you have included all necessary details to facilitate a smooth processing of your order.

Important dates for this form include the annual vaccine order deadlines set by the Missouri Department of Health and Senior Services. For the years 2024 and 2025, make sure to check official communications from the department for specific submission deadlines.

The purpose of the Pediatric Vaccine Order Form is to facilitate the ordering process for pediatric vaccines within the state of Missouri. It ensures that healthcare providers and clinics can request the necessary doses of various vaccines to maintain adequate supplies for their patients. By using this form, the Missouri Department of Health and Senior Services aims to streamline vaccine distribution and ensure timely immunizations for children. The form includes detailed sections for listing the requested vaccines, brands, doses, and National Drug Codes (NDC) to ensure accurate and efficient order processing. Healthcare providers must fill out the form with precise information to avoid any delays in their vaccine supply. This standardized form helps maintain consistency and organization in the vaccine ordering process across different healthcare facilities. Overall, the Pediatric Vaccine Order Form plays a crucial role in the vaccination program, supporting public health initiatives to protect children from preventable diseases. By facilitating the timely ordering and distribution of vaccines, the form helps healthcare providers uphold their commitment to patient care and immunization standards.

• 1. PROVIDER/CLINIC NAME: The name of the healthcare provider or clinic requesting the vaccines.
• 2. PIN: The unique identification number assigned to the provider or clinic.
• 3. VACCINE: The type of vaccine being requested.
• 4. BRAND: The brand name of the vaccine being ordered.
• 5. DOSES REQUESTED: The number of doses being requested for each vaccine.
• 6. NDC NUMBER: The National Drug Code number for the specific vaccine being ordered.
• 7. UNIT SHIPPING SIZE: The packaging and unit size for the vaccine doses.
• 8. ADDITIONAL DOSES REQUESTED FOR: Checkbox options to specify the reason for additional dose requests, such as Back to School, Disease Outbreak, or Other.

Failing to submit the Pediatric Vaccine Order Form may lead to delays in receiving necessary vaccines. This can result in shortages and impact timely immunizations for children.

• Vaccine Shortage: Healthcare providers may experience difficulties in maintaining adequate vaccine supplies.
• Delayed Immunizations: Children may face delays in receiving their scheduled vaccinations, increasing the risk of preventable diseases.
• Program Disruption: Public health initiatives and vaccination programs may be disrupted, affecting overall community health.

• 1. Routine Vaccination Orders: To maintain regular vaccine supplies for routine immunizations.
• 2. Back-to-School Immunizations: To order vaccines needed for student immunization before the school year starts.
• 3. Disease Outbreak Response: To request additional vaccines during a disease outbreak situation.
• 4. Clinic Vaccine Replenishment: To replenish vaccine stocks in healthcare clinics.
• 5. Public Health Vaccine Distribution: For public health officials managing vaccine distribution programs.