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Vaccines for Children Program (VFC) Program Forms

The table below reflects the forms needed to successfully comply with the regulations governing the Vaccines for Children Program.  Click on each title to bring up the PDF versions of each form described below.


 Patient Eligibility of Screening Record

Temperature Log for Vaccines in Freezer-Celsius

Temperature Log for Vaccines in Fridge-Fahrenheit

VFC Program Forms Request

Temperature Log for Vaccines in Fridge-Celsius Temperature Log for Vaccines in Freezer-Fahrenheit

Short-Dated Vaccine Report Form

Vaccine Contingency & Emergency Plan

Return to Immunization Program Main Page

Return to Immunizations - VFC Page


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