Vaccine Management Forms
- MDH Nonviable Vaccine Form (PDF)
Use this form to report nonviable (i.e., spoiled or expired) or lost MDH vaccine.
- MDH Vaccine Transfer
Form for transferring MDH vaccine to another site in order to prevent vaccine waste.
- VFC Vaccine Borrowing Report (PDF)
Borrowing occurs when a provider borrows vaccine from MnVFC stock to administer to a patient not eligible for the program, or when a provider borrows vaccine from private stock to use on MnVFC-eligible patients.
- Storage and Handling Mishap Log (PDF)
Document storage and handling incidents and actions taken.
- Storage and Handling Mishap Checklist (PDF)
Use this checklist when a storage and handling mishap has occurred.
- MDH Vaccine Restitution Appeal Form (PDF)
Form to file an appeal regarding the waste of the MDH vaccine.