Arizona Vaccines for Children (VFC) Operations Guide

Arizona Department of Health Services Home Page Banner

ADHS Home Page | A-Z Index | Public Health Services | Search | Contact ADHS

Arizona Immunization Program Office

Vaccines for Children (VFC) Operations Guide

2011 VFC Operations Guide

Exhibit 1A - Patient Eligibility Screening - English
Exhibit 1B - Patient Eligibility Screening - Spanish
Exhibit 2 - Childhood/Adolescent Immunization Administration Record
Exhibit 3 - Vaccine Adverse Event Reporting System (VAERS) Form
Exhibit 4 - Vaccine Information Statement
Exhibit 5 - Provider Enrollment Agreement
Exhibit 6A - Public Provider Profile
Exhibit 6B - Private Provider Profile
Exhibit 7A - VFC Provider License and AHCCCS Numbers
Exhibit 7B - VFC Provider and ASIIS VOM User Information
Exhibit 8 - Frozen Vaccine Requirements
Exhibit 9 - Refrigerator/Freezer Verification Form
Exhibit 10 - Vaccine Ordering Management System Manual
Exhibit 11 - Arizona VFC Patient Immunization Log
Exhibit 12 - Childhood/Adolescent Immunization Administration Record
Exhibit 13 - Refrigerator/Freezer Temperature Log
Exhibit 14 - Viable Vaccine Transfer Form
Exhibit 15 - Farenheit to Celcius Conversion Chart
Exhibit 16 - Vaccine Storage Temperature Recommendations
Exhibit 17 - Caution/Warning/Do Not Unplug Signs
Exhibit 18 - Waste/Expired Vaccine Return Form
Exhibit 19 - Vaccine Emergency Handling Plan
Exhibit 20 - VFC Provider Site Questionnaire

ADHS Web Privacy Policy. This page last modified on December 7, 2011 4:23 PM.
Copyright 2010 Arizona Department of Health Services. All rights reserved.
General comments, questions, or concerns: Customer Feedback