Mississippi State Department of Health

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

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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.)



Links referenced
What should be returned?    http://msdh.ms.gov/msdhsite/index.cfm/14,16871,71,pdf/NonViable_Vaccine_Returns.pdf
Online vaccine return form    https://app.smartsheet.com/b/form/f03db31faab0468bbad8b711a8df2834

Find this page at http://msdh.ms.gov/msdhsite/index.cfm/index.cfm

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