VFC Program Forms and Resources

Forms/Guidance Documents

1. Estimating Patient Population
2. VFC Enrollment Packet: Provider Agreement, Profile, and Storage and Handling Plan
3. Storage Unit Purchasing Guidance
4. Vaccine Storage Unit Maintenance
5. Guidance for Performing a Manual Freezer Defrost
6. Temperature Monitoring Device Guidance
7. Temperature Excursion Report
8. Temperature Log for Refrigerator – Fahrenheit
9. Temperature Log for Refrigerator – Celsius
10. Temperature Log for Freezer – Celsius
11. Temperature Log for Freezer – Fahrenheit
12. Separation of Public and Private Vaccines
13. Guidance for Vaccine Transport
14. Order Review Process
15. NYSIIS Returns/Wastage Training Handout
16. Job Aid: Monitoring Expiration Dates
17. Job Aid: Return or Discard
18. Vaccine Borrowing Form
19. Vaccine Restitution Policy
20. Patient Eligibility for Publicly-funded Vaccines
21. Fraud and Abuse Referral Sheet
22. NYS VFC Fridge-Tag2L Data Logger Training Slides
23. Pharmacy Provider Agreement
24. Pharmacy Storage and Handling Plan
25. Non-viable Vaccine Reporting Form
26. VFC Provider Type and Specialty Definitions

Resources for Providers

• Vaccine Storage and Handling Toolkit, Centers for Disease Control and Prevention
• Immunization Information for Providers, NYSDOH
• Storage and Handling Handouts: Clinic Resources, Immunization Action Coalition

For Parents

• Vaccines For Children: For Parents - U.S. Department Of Health & Human Services, Centers for Disease Control and Prevention, and National Immunization Program
• Frequently Asked Questions: Immunizing Your Child, Paying for Immunizations - American Academy of Pediatrics

Questions? Contact the New York State Vaccines for Children Program at nyvfc@health.ny.gov or 1-800-543-7568