VFC Program Forms

VOMS Training

VOMS Ordering Process v.4.2018  Online Training
VOMS Return & Waste Training V.12.2017 Online Training
VOMS Flu Pre-book Process V.1.2018 Online Training
Temperature Review and Reporting V.2.2018 Online Training

VOMS Training Materials

VOMS Ordering Process V.4.2018  Power Point, PDF
VOMS Returns & Waste Process V.12.2017  Power Point,  PDF
VOMS Flu Pre-book Process V.1.2018 Power Point, PDF
Temperature Review and Reporting V.2.2018 PowerPoint, PDF

Provider & Eligibility Forms

Eligibility Form - English
Eligibility Form - Spanish
Provider Profile and Enrollment Form
Provider Profile Adjustment Form
Vaccine Storage Certification Form

VFC Provider Regions

Salt Lake County Regions
State Regions

VFC Educational Materials

VFC Provider Manual   NEW
Billing Scenarios
VFC Eligible Flyer
VFC Funding Policy
VFC Provider Requirements

Report Forms

Doses Administered User Instructions

Storage & Handling Forms

Emergency Response Checklist   NEW
Emergency Vaccine Transport   NEW
Temperature Log (C)
Temperature Log (F)
Vaccine Storage Troubleshooting Record
Senso Help Sheet
Vaccine Management Plan
Vaccine Storage & Handling Guide

Tally Sheets

CHIP Tally Sheet
FQHC/RHC Tally Sheet (if your PIN begins with "F")
VFC Tally Sheet (for all ages)

Vaccine Forms

Vaccine Administration Record
Vaccine Inventory Form
Transfer Form

Resources

USIIS