Vaccine Return Form

Form 131. Please complete this Vaccine Return Form for any vaccine eligible for return by vaccine providers.

This page has been automatically translated from English. MSDH has not reviewed this translation and is not responsible for any inaccuracies.

Please complete this Vaccine Return Form for any vaccine eligible for return by vaccine providers.

(Amounts entered in this form must match amount of vaccine placed in shipping box for return, and what is being entered into MIIX.)

Last reviewed on Oct 13, 2021 request edits

Mississippi State Department of Health • 570 East Woodrow Wilson Dr • Jackson, MS 39216 • 866‑HLTHY4U • Contact and information