logo for MnVFC program picture of a baby picture of a little girl picture of a preteen boy

MnVFC Forms

Patient self-screening form
Patient eligibility screening record forms
Annual/semi-annual report forms
Other MnVFC vaccine forms

Subscribe to MnVFC Forms UpdatesSubscribe to MnVFC Forms Updates


Online ordering/vaccine order forms


Patient self-screening form


Patient eligibility screening record forms


Annual/semi-annual report forms


Other forms:

  • VFC Vaccine Borrowing Report (PDF: 129KB/1 pages)
    When a provider has borrowed vaccine from one stock to administer to a child who is only eligible to receive vaccine from the other stock, this form must be completely filled out for each borrowing occurrence.

Updated Thursday, May 08, 2014 at 03:07PM