MnVFC Forms - Minnesota Dept. of Health
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MnVFC Forms

On this page:
Online ordering/vaccine order forms
Patient self-screening forms

Patient eligibility screening record forms
Annual reports and forms
Other forms

Online ordering/vaccine order forms

Patient self-screening form

Patient eligibility screening record forms

Annual reports and forms

Separate Stock Sites

  • 2017 Minnesota Vaccines for Children (MnVFC) Program Provider Agreement
    Coming soon
  • 2017 Minnesota Vaccines for Children (MnVFC) Program Annual Report of the Number of Immunized Pediatric Patients
    Coming soon

Replacement Method Sites

Other forms:

  • Vaccine Borrowing Report (PDF)
    When a provider has borrowed vaccine from one stock to administer to a patient who is only eligible to receive vaccine from the other stock, this form must be completely filled out for each borrowing occurrence.

Updated Friday, September 23, 2016 at 11:22AM