VFC Program Forms and Resources

Forms/Guidance Documents

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

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