PDF
Word
Form IMM-12 Retrospective Immunization Audit / Survey - New Jersey
What Is Form IMM-12?
This is a legal form that was released by the New Jersey Department of Health - a government authority operating within New Jersey. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is form IMM-12?
A: Form IMM-12 is a Retrospective Immunization Audit/Survey.
Q: What is the purpose of form IMM-12?
A: The purpose of form IMM-12 is to conduct a retroactive audit of immunization records.
Q: Who is required to complete form IMM-12?
A: Healthcare providers in New Jersey are required to complete form IMM-12.
Q: What information is collected on form IMM-12?
A: Form IMM-12 collects information about the immunization history of individuals.
Q: Is form IMM-12 specific to New Jersey?
A: Yes, form IMM-12 is specific to New Jersey.
Form Details:
- Released on July 1, 2012;
- The latest edition provided by the New Jersey Department of Health;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a printable version of Form IMM-12 by clicking the link below or browse more documents and templates provided by the New Jersey Department of Health.
