Forms
VFC Emergency Vaccine Management Plan
Immunization - Form
October 17, 2018
The New Mexico VFC Program requires each practice to develop and maintain an Emergency Vaccine Management Plan. Properly completing this template will meet the VFC Program requirement to have a written plan for storage and handling procedures in an emergency.
School Consent to Enter Student Records into NMSIIS
Immunization - Form
September 17, 2018
This is a customizable form for use by schools to collect consent from parents so students' historic immunization records may be added to NMSIIS.
VFC Vaccine Borrowing Form
Immunization - Form
July 26, 2018
Borrowing vaccines between VFC and State inventories can only take place due to unforeseen delays or circumstances surrounding the vaccines that were ordered. The provider must assure that borrowing VFC vaccines will not prevent a VFC eligible child from receiving a needed vaccination because VFC vaccine was administered to a non-VFC eligible (State) child.
VFC New Provider Application
Immunization - Form
March 23, 2018
All VFC providers are required to submit this annual VFC certification form in order to continue receiving VFC vaccines.
VFC Approved School Sites - Needle, Syringe, & e-kit Order Form
Immunization - Form
February 23, 2018
This form is to be used for needles/syringes, and e-kit medications and is for Vaccines for Children Approved Sites Only.
VFC Middle School Vaccination Letter/Permission Form
Immunization - Form
February 23, 2018
This is the letter addressed to parents or legal guardians to determine whether or not a child is to be vaccinated at school. This letter is to be sent out with the VFC school immunization consent form.
VFC Middle School Vaccination Letter/Permission Form (Spanish)
VFC Program Data Logger Timeline and Checklist
Immunization - Form
January 26, 2018
This document is for providers: guidelines and important dates for the transition to digital data loggers.
VFC Southwest Region Temperature Log Form
Immunization - Form
January 2, 2018
Catron, Dona Ana, Grant, Hidalgo, Luna, Otero, Sierra, and Socorro
VFC Southeast (B) Region Temperature Log Form
Immunization - Form
January 2, 2018
Eddy, Lea, Lincoln, and Roosevelt
VFC Southeast (A) Region Temperature Log Form
Immunization - Form
January 2, 2018
Chaves, Curry, DeBaca, Lincoln, and Quay
VFC Northwest Region Temperature Log Form
Immunization - Form
January 2, 2018
Cibola, McKinley, San Juan, Sandoval, Torrance, and Valencia
VFC Northeast Region Temperature Log Form
Immunization - Form
January 2, 2018
Colfax, Guadalupe, Harding, Los Alamos, Mora, Rio Arriba, San Miguel, Santa Fe, Taos, and Union
VFC Routine Vaccine Management Plan
Immunization - Form
January 2, 2018
The New Mexico VFC Program requires each practice to develop and maintain a Routine Vaccine Management Plan. Properly completing this template will meet the VFC Program requirement for VFC Program participants to have written vaccine storage and handling plans.