Get the free MnVFC Pediatric Influenza Vaccine Order Form - health state mn

This document serves as a notification and order form for the Minnesota Vaccines for Children (MnVFC) program, specifically for ordering influenza vaccines for eligible children.

How to fill out mnvfc pediatric influenza vaccine

How to fill out MnVFC Pediatric Influenza Vaccine Order Form

1. Obtain the MnVFC Pediatric Influenza Vaccine Order Form from the MnVFC website or your local health department.
2. Fill in the provider's name, address, and contact information at the top of the form.
3. Indicate the specific vaccine type and dosage required for your pediatric patients.
4. List the number of doses needed for each age group specified.
5. Double-check that all required fields are completed accurately.
6. Sign and date the form at the designated area.
7. Submit the completed form to the MnVFC program via the specified method (fax, email, or online submission).

Who needs MnVFC Pediatric Influenza Vaccine Order Form?

1. Healthcare providers who serve children in need of influenza vaccination through the MnVFC program.
2. Clinics and hospitals that provide pediatric care and want to receive influenza vaccines at no cost.

People Also Ask about

How does the vaccines for children program work?

The Vaccines for Children Program (VFC) is a federally funded program in the United States providing no-cost vaccines to children who lack health insurance or who otherwise cannot afford the cost of the vaccination.

What vaccinations are required for school in Minnesota?

WHICH IMMUNIZATIONS ARE REQUIRED. For the safety of all children, Minnesota law requires written proof that your child has been immunized against seven diseases: diphtheria, tetanus, pertussis (DTP), measles, mumps, rubella (MMR) and polio.

What is the Minnesota vaccines for children MnVFC program?

Minnesota Vaccines for Children (MnVFC) program The MnVFC program offers free or low-cost vaccines for eligible children age 18 years and younger. This helps ensure that children are vaccinated on time by not letting the cost of vaccines prevent a parent or guardian from having their child receive recommended vaccines.

Can I refuse to vaccinate my child in MN?

Non-medical exemption: A parent/guardian must sign for a non-medical exemption and the form must be signed and stamped by a notary. A child is not required to have an immunization that is against their parent or guardian's beliefs.

What vaccines do you need to go to school in Minnesota?

WHICH IMMUNIZATIONS ARE REQUIRED. For the safety of all children, Minnesota law requires written proof that your child has been immunized against seven diseases: diphtheria, tetanus, pertussis (DTP), measles, mumps, rubella (MMR) and polio.

For pdfFiller’s FAQs

What is MnVFC Pediatric Influenza Vaccine Order Form?

The MnVFC Pediatric Influenza Vaccine Order Form is a document used by healthcare providers in Minnesota to request influenza vaccines for children participating in the Minnesota Vaccines for Children (MnVFC) program.

Who is required to file MnVFC Pediatric Influenza Vaccine Order Form?

Healthcare providers that participate in the MnVFC program and wish to receive influenza vaccines for eligible pediatric patients are required to file the MnVFC Pediatric Influenza Vaccine Order Form.

How to fill out MnVFC Pediatric Influenza Vaccine Order Form?

To fill out the MnVFC Pediatric Influenza Vaccine Order Form, providers must provide their clinic information, the number of doses needed based on patient eligibility, and any other required details specified in the form instructions.

What is the purpose of MnVFC Pediatric Influenza Vaccine Order Form?

The purpose of the MnVFC Pediatric Influenza Vaccine Order Form is to ensure that healthcare providers can obtain the necessary influenza vaccines for eligible children, thereby improving vaccination rates and public health.

What information must be reported on MnVFC Pediatric Influenza Vaccine Order Form?

Information that must be reported on the MnVFC Pediatric Influenza Vaccine Order Form includes provider details, the requested number of vaccine doses, the clinic's MnVFC provider number, and any additional information as required by the state health department.