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

Please note: Some of the files available on this page are in Adobe PDF format which requires Adobe Acrobat Reader. A free copy of Adobe Acrobat Reader can be downloaded directly from Adobe . If you are using an assistive technology unable to read Adobe PDF, please either view the corresponding text only version (if available) or visit Adobe's Accessibility Tools page.

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