Vaccine Provider Certification Package

Vaccine Provider Certification Packet

• Provider Certification Enrollment/Survey Form
• Alaska Vaccine Distribution Program Handbook

VFC Forms

• VFC Group Report Form
• VFC Eligibility Screening Form

Vaccine Distribution Program Forms

• Vaccine Order Form
• Vaccine Usage Report Form
• Vaccine Return & Facility Incident Report Forms
• Emergency / Power Outage Plan for Vaccines
• Emergency / Power Outage Plan for Vaccines (editable)
• Vaccine Temperature Log
• Counter Top Display Sign
• Adverse Reaction Reporting Form

Vaccine Information Statements

• Multiple Vaccine - This 4-page VIS may be used as an optional substitute for any or all of the routine birth-6 month vaccine VISs: DTaP, IPV, Hib, PCV, Hepatitis B, and Rotavirus.

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