Jul 1, 2024 · All VFC Program providers must screen for a child's eligibility to receive vaccines through the VFC Program and record the screening results during each visit. The patient eligibility screening record provides a means of recording parent responses to …

Use this form to document the eligibility status of the patient. See Storage & Handling Job Aids for temperature logs, data logger guides, and vaccine transport guidance available for all vaccination programs! Reportable diseases and conditions, Title 17, California Code of Regulations.

This form documents the eligibility status of the patient named above. The health care provider must keep this record for the VFC-eligible child for no less than three (3) years and make it available to state or federal officials for inspectionupon request.

Oct 1, 2012 · Screening Form; Health Department Vaccine Use Guidelines; Adult Vaccine Order Form; Split-dose box labels 50 (For use with Avery 8195. Label size: 2/3” x 1¾” )

To be VFC-eligible, patients must meet at least one of these four criteria: • Medicaid-eligible (or enrolled) : Has Medi-Cal as primary or secondary coverage • American Indian (AI) or Alaska Native (AN): As defined by the Indian Health Care Improvement Act

To determine if a child (0 through 18 years of age) is eligible to receive federal vaccine through the VFC and state programs, at each immunization encounter/visit enter the date and mark the appropriate eligibility category. If Column A-D is marked, the child is eligible for the VFC program.

Check the appropriate eligibility category line below for children (up to their 19th birthday) who receive publicly purchased vaccine in New York. All children enrolled in Medicaid or any Medicaid managed care plan should be entered here.

VFC eligibility screening and documentation must take place with each immunization visit and recorded in MCIR. Providers may also utilize the below form to document screening.

The following forms, charts and handouts maybe downloaded and used by you and your staff to complete necessary Vaccines for Children (VFC) and COVID-19 program requirements.

Jun 28, 2024 · To enroll in the VFC Program: Contact your state/local/territory VFC Program coordinator to request enrollment. Complete and return the State Provider Enrollment forms as soon as possible.