VFC Enrollment & Recertification
- Enrollment instructions and online forms
- Key Practice Staff Change Request form
- Participation Withdrawal Request Form
- Recertification is required annually. Access the on-line form from your MyVFCvaccines account. Utilize the Recertification Worksheet to help gather this information ahead of time.
Patient Eligibility
- Patient Eligibility Screening Record for VFC
- Patient Eligibility Screening Record (Spanish)
Use this form to document the eligibility status of the patient. - VFC Eligibility Screening and Documentation Requirements
Vaccine Management
- Vaccine Management Plan – word template | pdf
- Vaccine Physical Inventory Form
- Daily Usage Logs: | VFC Vaccine | Private | Flu
- Refrigerator Temperature Logs Fahrenheit | Celsius
- Freezer Temperature Logs Fahrenheit | Celsius
- Vaccine Receiving Log and Checklist
- Frozen Vaccine Transport Log
- Refrigerated Vaccine Transport Log
- Ordering Vaccines: Routine | Flu
Documentation of Tdap Administration
Disease Reporting
- Legal Requirements for Reporting Diseases
Reportable diseases and conditions, Title 17, California Code of Regulations. - Communicable Disease Control Forms
A collection of forms to be used to report diseases to the State of California. - Guidance for Local Health Jurisdictions on reporting vaccine-preventable diseases to CDPH
Patient Care
- Immunization Record & History form
- Vaccine Adverse Event Reporting System (VAERS)
To report adverse events after administration of US licensed vaccines. - Vaccine Error Reporting Program (VERP)
To report preventable vaccine administration errors.