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

For Parents

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