COVID-19 Vaccine Transfer Request

All enrolled COVID-19 vaccine providers are required to upload temperature logs/data logger reports when submitting a transfer request.
 
Doses CANNOT be moved prior to approval from the Immunization Program.
 
Please allow (1) business day for approval.
 
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Do you want CDPHE to create the transfer in CIIS for your facility?
IF YOU WILL CREATE THE TRANSFER IN CIIS YOURSELF, PLEASE SELECT " NO" *
If you don't see a clinic listed in the drop down menu, you CANNOT transfer vaccine to them. This will be updated nightly as new sites are enrolled.
Please list vaccine that you wish to transfer.
DO NOT FILL THIS FORM OUT MORE THAN ONCE FOR THE SAME TRANSFER.
 Vaccine BrandLot NumberExpirationNumber of DOSES (not vials) you wish to transfer
1
2
3
4
5
Have any of the vaccines that you intend to transfer been exposed to temperatures outside of recommended storage requirements? *
If yes, please give the receiving clinic the manufacturer recommendations and lot number information.
The Immunization Branch will review this information and respond within one business day to the email provided in this form.
Thank you.