{"id":9547,"date":"2025-03-01T13:58:55","date_gmt":"2025-03-01T18:58:55","guid":{"rendered":"https:\/\/dhss.delaware.gov\/dph\/vfc-programforms\/"},"modified":"2025-03-02T00:25:44","modified_gmt":"2025-03-02T05:25:44","slug":"vfc-programforms","status":"publish","type":"page","link":"https:\/\/dhss.delaware.gov\/dph\/dpc\/vfc-programforms\/","title":{"rendered":"dpc\/vfc-programforms ~  Vaccines for Children Program (VFC) Program Forms  &#8211; Delaware Health and Social Services &#8211; State of Delaware"},"content":{"rendered":"<div data-swiftype-index=\"true\">\n\n\n\n\n\n  <br>\n\n\n  \n\n\n\n\n\n  \n\n\n  <div class=\"container\" id=\"main_header\">\n\n\n    \n\n\n\n\n\n <!-- BEGIN readspeaker div -->\n\n\n    <div class=\"rs_skip rsbtn rs_preserve\" id=\"readspeaker_button1\">\n\n\n      <a accesskey=\"L\" class=\"rsbtn_play\" href=\"https:\/\/app-na.readspeaker.com\/cgi-bin\/rsent?customerid=7262&#038;lang=en_us&#038;readid=main_content&#038;url=https:\/\/dhss.delaware.gov\/dph\/dpc\/vfc-programforms.html\" title=\"Listen to this page using ReadSpeaker\">\n\n\n        <span class=\"rsbtn_left rsimg rspart\"><span class=\"rsbtn_text\"><span>Listen<\/span><\/span><\/span>\n\n\n        <span class=\"rsbtn_right rsimg rsplay rspart\"><\/span>\n\n\n      <\/a>\n\n\n    <\/div>\n\n\n    <!-- END readspeaker div -->\n\n\n\n\n\n\n\n\n    \n\n\n    <header class=\"pull-left\">\n\n\n      <h1><!--[type=EDIT name=\"Page Title\"]-->Vaccines for Children Program (VFC) Program Forms<!--[END]--><\/h1>\n\n\n    <\/header>\n\n\n    \n\n\n  <\/div><br>\n\n\n \n\n\n  <div class=\"container\">\n\n\n    <div class=\"row\">\n\n\n      <div class=\"col-md-3\" id=\"leftCol\">\n\n\n        <div class=\"panel-group\" id=\"accordion\">\n\n\n          <div class=\"panel sectionmenu_panel\">\n\n\n            <div class=\"panel-heading\">\n\n\n              <p class=\"panel-title\"><a class=\"agency_nav\" data-parent=\"#accordion\" data-toggle=\"collapse\" href=\"#collapseOne\"><strong><i class=\"fa fa-align-justify fa-fw\"><\/i> Public Health Menu<\/strong><\/a><\/p>\n\n\n            <\/div>\n\n\n\n\n\n            <div class=\"panel-collapse collapse in\" id=\"collapseOne\">\n\n\n              <div class=\"panel-body\" id=\"clf_nav\">\n\n\n                  <ul class=\"nav nav-stacked nav-pills-clf\" id=\"agency_sidebar\">\n    <li><a href=\"\/dph\/\"><h2>Home <i class=\"fa fa-home fa-fw\"><\/i><\/h2><\/a><\/li>\n    <li class=\"toplevel\"><a data-parent=\"#agency_sidebar\" data-toggle=\"collapse\" href=\"#HomeMenu\"><h2>About <i class=\"fa fa-caret-right fa-fw\"><\/i><\/h2><\/a>\n      <ul class=\"panel-collapse collapse\" id=\"HomeMenu\">\n        <li><a href=\"\/dph\/about.html\">About DPH<\/a><\/li>\n        <li><a href=\"\/dph\/sections.html\">Sections &#038; 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height: 28px;\">\n\n\n\n   <p style=\"text-align: center; margin-left: -11.25pt;\"><span style=\"color:#8B4513;\">\u00a0<\/span><u><a href=\"\/wp-content\/uploads\/sites\/10\/dph\/pdf\/patienteligibilityofscreeningrecord.pdf\"><span style=\"color:#8B4513;\">Patient Eligibility of Screening Record<\/span><\/a><\/u><\/p>\n\n\n\n   <\/td>\n\n\n\n   <td style=\"width: 204.43px; height: 28px;\">\n\n\n\n   <p align=\"center\"><u><a href=\"\/wp-content\/uploads\/sites\/10\/dph\/pdf\/freezercelsius.pdf\"><span style=\"color:#8B4513;\">Temperature Log for Vaccines in Freezer-Celsius<\/span><\/a><\/u><\/p>\n\n\n\n   <\/td>\n\n\n\n  <\/tr>\n\n\n\n  <tr>\n\n\n\n   <td style=\"width: 200.57px; height: 28px;\">\n\n\n\n   <p align=\"center\"><u><a href=\"\/wp-content\/uploads\/sites\/10\/dph\/pdf\/tempuraturelogfridgefarenheit.pdf\"><span style=\"color:#8B4513;\">Temperature Log for Vaccines in Fridge-Fahrenheit<\/span><\/a><\/u><\/p>\n\n\n\n   <\/td>\n\n\n\n   <td style=\"width: 204.43px; height: 28px;\">\n\n\n\n   <p align=\"center\"><u><a href=\"\/wp-content\/uploads\/sites\/10\/dph\/pdf\/VFCrequestfillable.pdf\" style=\"color: rgb(178, 170, 164); text-align: center;\"><span style=\"color:#8B4513;\">VFC Program Forms Request<\/span><\/a><\/u><\/p>\n\n\n\n   <\/td>\n\n\n\n  <\/tr>\n\n\n\n  <tr>\n\n\n\n   <td style=\"width: 200.57px; height: 28px;\"><u><a href=\"\/wp-content\/uploads\/sites\/10\/dph\/pdf\/tempuraturelogfridgecelsius.pdf\" style=\"color: rgb(178, 170, 164); text-align: -webkit-center;\"><span style=\"color:#8B4513;\">Temperature Log for Vaccines in Fridge-Celsius<\/span><\/a><\/u><\/td>\n\n\n\n   <td style=\"width: 204.43px; height: 28px;\"><u><a href=\"\/wp-content\/uploads\/sites\/10\/dph\/pdf\/tempuratureforfreezerfarenheit.pdf\" style=\"color: rgb(178, 170, 164); text-align: -webkit-center;\"><span style=\"color:#8B4513;\">Temperature Log for Vaccines in Freezer-Fahrenheit<\/span><\/a><\/u><\/td>\n\n\n\n  <\/tr>\n\n\n\n  <tr>\n\n\n\n   <td style=\"width: 200.57px; height: 28px;\">\n\n\n\n   <p align=\"center\"><u><a href=\"\/wp-content\/uploads\/sites\/10\/dph\/pdf\/ShortDatedVaccineReportForm03_10_22fillable.pdf\"><span style=\"color:#8B4513;\">Short-Dated Vaccine Report Form<\/span><\/a><\/u><\/p>\n\n\n\n   <\/td>\n\n\n\n   <td style=\"width: 204.43px; height: 28px;\">\n\n\n\n   <p align=\"center\"><u><a href=\"\/wp-content\/uploads\/sites\/10\/dph\/pdf\/vaccinecontingencyplantemplate.pdf\"><span style=\"color:#8B4513;\">Vaccine Contingency &#038; Emergency Plan<\/span><\/a><\/u><\/p>\n\n\n\n   <\/td>\n\n\n\n  <\/tr>\n\n\n\n  <tr>\n\n\n\n   <td style=\"width: 200.57px; height: 28px;\">\n\n\n\n   <p align=\"center\"><strong><a href=\"immunize.html\" style=\"color: rgb(178, 170, 164);\"><span style=\"color:#8B4513;\">Return to Immunization Program Main Page<\/span><\/a><\/strong><\/p>\n\n\n\n   <\/td>\n\n\n\n   <td style=\"width: 204.43px; height: 28px;\">\n\n\n\n   <p align=\"center\"><strong><a href=\"immunize-vfc.html\"><span style=\"color:#8B4513;\">Return to Immunizations &#8211; VFC Page<\/span><\/a><\/strong><\/p>\n\n\n\n   <\/td>\n\n\n\n  <\/tr>\n\n\n\n <\/tbody>\n\n\n\n<\/table>\n\n\n\n\n\n\n\n<p>\u00a0<\/p>\n\n\n\n\n\n\n\n<p><br>\n\n\n\n<\/p><p class=\"smalltext\"><a href=\"http:\/\/www.adobe.com\/products\/acrobat\/readstep2.html\"><img loading=\"lazy\" decoding=\"async\" alt=\"Download Adobe Acrobat Reader\" height=\"21\" src=\"\/wp-content\/uploads\/dhss\/img\/getacro60.gif\" width=\"60\"><\/a> Please note: Some of the files available on this page are in Adobe PDF format which requires Adobe Acrobat Reader.  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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&#8217;s <a href=\"http:\/\/access.adobe.com\">Accessibility Tools page<\/a>.<\/p>\n\n\n\n\n\n\n\n<p>\u00a0<\/p>\n\n\n\n  <!--[END]-->\n\n\n  \n\n\n      <\/div>\n\n\n    <\/div>\n\n\n  <\/div><!-- \/container -->\n\n\n<\/div>","protected":false},"excerpt":{"rendered":"<p>Listen Vaccines for Children Program (VFC) Program Forms Public Health Menu Home About About DPH Sections &#038; Programs Office Locations Contact Info Calendar Services A-Z Services Air &#038; Water Quality Birth, Death, &#038; Marriage Records Clinics Health Data &#038; Statistics Emergency Preparedness Health &#038; Wellness Healthy Homes Healthy Workplaces Laboratory Restaurant Inspections Screening and Testing [&hellip;]<\/p>\n","protected":false},"author":8,"featured_media":0,"parent":9401,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"class_list":["post-9547","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/9547","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/users\/8"}],"replies":[{"embeddable":true,"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/comments?post=9547"}],"version-history":[{"count":1,"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/9547\/revisions"}],"predecessor-version":[{"id":10786,"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/9547\/revisions\/10786"}],"up":[{"embeddable":true,"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/9401"}],"wp:attachment":[{"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/media?parent=9547"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}