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

These annual reports and forms are due by Nov. 30, 2016.

Separate Stock Sites

  • 2017 Minnesota Vaccines for Children (MnVFC) Program Annual Report of the Number of Immunized Pediatric Patients
    If your site submits dose-level eligibility (DLE) information to MIIC, you can collect the count of pediatric patients using the "MnVFC Report" function in MIIC. See the MnVFC Reports in MIIC user guide on Vaccine Ordering and Management in MIIC

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 Thursday, September 29, 2016 at 04:41PM