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Photo of the publication cover. VFC Southeast (A) Region Temperature Log Form Immunization - Form June 29, 2020

Chaves, Curry, DeBaca, Lincoln, and Quay



Photo of the publication cover. VFC Southeast (B) Region Temperature Log Form Immunization - Form June 29, 2020

Eddy, Lea, Lincoln, and Roosevelt



Photo of the publication cover. VFC Southwest Region Temperature Log Form Immunization - Form June 29, 2020

Catron, Dona Ana, Grant, Hidalgo, Luna, Otero, Sierra, and Socorro



Photo of the publication cover. VaxViewNM Demographic and Contact Information Form Immunization - Form April 15, 2020

VaxViewNM Demographic and Contact Information Form



Photo of the publication cover. Certificate of Exemption from Immunization (English) Immunization - Form April 14, 2020

This form may be used by individuals requesting a religious or medical exemption to immunization for their children whom attend any public, private or parochial pre-school, kindergarten, elementary, secondary school, or home school and for children attending daycare of childcare facilities.

Certificate of Exemption FAQ



Photo of the publication cover. Certificate of Exemption from Immunization (Spanish) Immunization - Form April 14, 2020

This form may be used by individuals requesting a religious or medical exemption to immunization for their children whom attend any public, private or parochial pre-school, kindergarten, elementary, secondary school, or home school and for children attending daycare of childcare facilities.



Photo of the publication cover. VFC Transport Temperature Log Form for Refrigerated Vaccines Immunization - Form February 14, 2020

Complete this log when transporting vaccines to an alternate or back-up refrigerator, or when transferring to another provider.



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 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)



Photo of the publication cover. 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.



Photo of the publication cover. 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.



Photo of the publication cover. 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 Instructions on Digital Signature and Attaching License



Photo of the publication cover. 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.



Photo of the publication cover. 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)



Photo of the publication cover. 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.



Photo of the publication cover. Adult Vaccine Order Form Immunization - Form October 10, 2017

Healthcare providers may use this form to order adult vaccines.



Photo of the publication cover. Adult Vaccine Return Form Immunization - Form October 10, 2017

This form is used by Healthcare providers to return Adult Vaccines.



Photo of the publication cover. Immunization Assessment Worksheet for 7th Grade Immunization - Form September 8, 2017

Immunization Assessment Worksheet for 7th Grade



Photo of the publication cover. Immunization Assessment Worksheet for Kindergarten Immunization - Form September 8, 2017

Immunization Assessment Worksheet for Kindergarten

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