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Forms


Photo of the publication cover. VFC Emergency Vaccine Management Plan Immunization - Form November 22, 2019

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.



Photo of the publication cover. VFC Routine Vaccine Management Plan Immunization - Form November 22, 2019

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.



Photo of the publication cover. VFC Troubleshooting Record Form Immunization - Form October 19, 2019

This form should be used to report out of range temperature incidents and submit a troubleshooting record to the vaccines for children program.



Photo of the publication cover. Adult Vaccine Consent Form Immunization - Form September 9, 2019

This form may be used by adult patients aged 19 and older to provide vaccination consent to a healthcare provider.

Adultos Vacuna Formulario de Consentimiento



Photo of the publication cover. VFC Vaccine Administration Form (Part B) Immunization - Form September 9, 2019

This form allows you to provide immunization information for entry into NMSIIS.

VFC Vacuna Forma Administración (Parte B)



Photo of the publication cover. VFC School Immunization Consent Form Immunization - Form August 29, 2019

This is the form to be completed by parents or guardians indicating whether or not a child is to be vaccinated at school.

VFC School Immunization Consent Form (Spanish)