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MnVFC Forms

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

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Online ordering/vaccine order forms


Patient self-screening form


Patient eligibility screening record forms


Annual report forms


Other forms:

  • VFC Vaccine Borrowing Report (PDF: 88KB/2 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 Monday, September 29, 2014 at 03:17PM