The Florida Vaccines for Children Program
Provider Handbook
Vaccines for Children Program Provider Handbook Available on CD
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January 19, 2010 -- The Bureau of Immunization is pleased to announce the current Vaccines for Children (VFC) Program Provider Handbook is now available on CD. To request a copy, please contact the VFC Program by email at FloridaVFC@doh.state.fl.us, or by calling 800-483-1543.
Provider Forms
Last update: June 23, 2009
Links below are Adobe Acrobat PDF files of 1.8 MB or less and open in new window.
- Cover
- Executive Summary - October 19, 2009
- Cover Letter
- Table of Contents
- Modules
- Appendices
- A-1 – Federally Qualified Health Centers and Florida Rural Health Centers - October 19, 2009
- A-2 – Eligibility Forms
- June 24, 2009
- Patient Eligibility Screening Record Florida Vaccine for Children Program
- Comprehensive Certification Form for American Indians and Alaskan Natives
- Comprehensive Certification Form for Children Who Are Enrolled in Medicaid
- Patient Eligibility Screening Record, Vaccines for Children Program in Family Planning Clinics
- Family Planning Clinic, Unaccompanied Minor without Insurance Information VFC Vaccine Log
- Maximum Regional Charges for Vaccine Administration By State
- A-3 – Provider Enrollment Forms
- October 19, 2009
- Provider Initial Enrollment Form
- Provider Recertification Form
- Disenrollment Form
- A-4 – VFC Reporting Forms
- November 13, 2009
- Vaccine Report Form
- Additional Information Form
- Varicella-containing Vaccine Order Form
- Vaccine Usage Worksheet
- Vaccine Inventory Balance Sheet
- Vaccine Return and Waste Form
- Vaccine Transfer Form
- Request to Transport and Administer Vaccines to Off-site Immunization Activities Form
- Vaccine Request Form for Off-site Immunization Activities
- Transporting and Administering Vaccines to Off-site Immunization Activities (Cooler Temperature Log [Sample])
- A-5 – Vaccine Management
- October 19, 2009
- Storage Resources
- Checklist for Safe Vaccine Handling and Storage
- Temperature Log for Vaccines (Fahrenheit/Celsius)
- Thermometer Product Resources
- Display Materials
- Don’t Be Guilty of These Errors in Vaccine Storage and Handling Flyer
- Handle Vaccines with Care Refrigerator Magnet
- Do Not Unplug Sticker
- Emergency Storage and Handling
- Emergency Response Plan (Sample)
- Emergency Response Worksheet
- Emergency Vaccine Storage and Handling Advisory
- Recommendations for Storage and Handling of Selected Biologicals
- A-6 – Vaccine Administration
- October 19, 2009
- Vaccine Administration Record for Children and Teens
- Uniform Vaccine Administration Record
- Instructions for the Use of Vaccine Information Statements
- A-7 – Provider Compliance and Monitoring
- October 19, 2009
- Vaccine Adverse Event Reporting System (VAERS)
- List of Revised Standards for Child and Adolescent Immunization Practices
- Standards for Pediatric Immunization Practices Questionnaire
- VFC Provider Site Visit Questionnaire
- A-8 – Miscellaneous Information
- October 19, 2009
- VFC Program Contact Information
- Immunization Resources on the Web
- Website Links to Access VFC Forms
- Suspected Fraud and Abuse Report Form
Download complete
manual in one Zip file - November 13, 2009 - Zip files may require the installation of WinZip on pre-Windows XP machines. You may download a free trial version at: http://www.winzip.com/downwz.htm.
