Transcription of BIOLOGICALS ORDER FORM - BC Centre for Disease Control
1 BCCDC will autosubstitute product as Minimum stock level - minimum number of doses to be always on hand - 1 month supply2 Doses on Hand - number of doses on hand at date of ORDER (counted in fridge)3 Doses requested - number of doses requested from BCCDC, considering age cohort and upcoming re-ordering formula:Minimum stock level - doses on hand = doses requestedExample, 100 doses - 50 doses in the fridge = re- ORDER 50 dosesApproved by:NON-STANDARD VACCINES: ORDER DATE (YYYY/MM/DD):Sender Name & Phone:Measles, Mumps, Rubella, Priorix, 10 doses per boxInfluenza, General Population and 65+, 10 doses per boxInactivated Polio, Imovax Polio, 1 dose per boxBIOLOGICALS DESKPHONE: 604-707-2582 FAX: 604-707-2581 STANDARD VACCINES:Hepatitis B, grade 6/adult, Engerix B Hepatitis A, adult, Havrix 1440 Hepatitis B, infant, Engerix B PediatricHepatitis B, dialysis, RecombivaxRotavirus, RotaTeq, 1 dose per boxMMRV, ProQuad, 10 doses per boxTetanus Immune Globulin, HypertetImmune Serum Globulin, Gamastan, 2 ml per vialTdaP, Grade 9, Boostrix, 10 doses per boxTd Adsorbed, 5 doses per boxOTHER:TB Skin Test, Tubersol, 10 doses per boxTdap-IPV, Boostrix-Polio, 10 doses per boxThis form is available at:NOTES:Hepatitis A, pediatric, Havrix 720 JuniorMeningococcal Conjugate C, NeisVac-C, 10 doses per boxPneumococcal Conjugate 13, Prevnar 13, 10 doses per boxEMAIL TO: BIOLOGICALS ORDER form Doses on hand2 Minimum stock level1 Doses Requested3 Varicella, Varilrix, 10 doses per boxPneumococcal Polysaccharide 23, Pneumovax 23, 10 doses per boxHEALTH UNITM eningococcal Conjugate, A/C/Y/W-135, grade 9, NimenrixSHIP TO.
2 Human Papillomavirus, grade 6, Gardasil 9, 10 doses per boxDTaP/HB/IPV/Hib, Infanrix Hexa, 10 doses per boxDTaP/IPV/Hib, Pediacel, 5 doses per boxHaemophilus influenzae type b, Act-Hib, 5 doses per boxVersion date: April 27, 2018
