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215-685-6784
215-238-6944
Complete the online reporting agreement form
Or fill out the
then email it to
vaxreporting@phila.gov
or fax to the contact above.
Complete in addition to the reporting agreement form to onboard more than 2 clinics.
Need help? Review the FAQ
Provider Reporting Agreement Form FAQDownload ...
International Record Review Guide 8-14-2025Download ...
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