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Recertification
Online Provider Recertification
Recertification is required annually. You can use the
online system link above, or this printable pdf form.
Vaccine Inventory Management
Vaccine Order Form
A one page form used for ordering all available VFC vaccines.
Return/Transfer of VFC Vaccine
A form for shipping vaccines.
Disease Reporting
Legal Requirements for Reporting Diseases
Reportable diseases and conditions, Title 17, California Code of Regulations, in a one page document.
Communicable Disease Control Forms
A collection of forms to be used to report diseases to the State of California.
Confidential Morbidity Report
A one page patient form.
Monitoring Temperatures
Refrigerator-only Temp Log: Fº | Cº
Freezer-only Temp Log: Fº | Cº
Combination Temperature Log: Fº | Cº
Patient Care
Vaccine Adverse Event Reporting System (VAERS)
VAERS is a post-marketing safety surveillance program, collecting information about adverse events (possible side effects) that occur after the administration of US licensed vaccines.
Enrollment
Enrollment Request
A one page form for requesting an enrollment packet.
Provider Enrollment
A pdf form for submitting contact information and agreeing
to the conditions of the program.
Patient Eligibility Screening
A one page form used to determine if a child is eligible to receive
VFC vaccines.
Dis-Enrollment
A one page form used for leaving the program.