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Health Department
Health and Community Services
43525 Elizabeth Road, Mount Clemens, MI 48043
(586) 469-5235

Dispense Assist

This page is for training and exercise purposes only

Please note that the information you enter on this form is not saved or stored in any way.  Please print two forms.  When picking up medication, one will be returned to you for your records and the other will be turned in to the Health Department.

Influenza Vaccine Screening Form

Anthrax Medication Screening Form

Plague Screening Form

Tularemia Screening Form

This form is provided by Dispense Assist: © Johnson County, Kansas Health Department