Get the free VACCINES FOR CHILDREN (VFC) PROGRAM PROVIDER ENROLLMENT FORM - cdph ca

Este formulario es para que los proveedores se inscriban en el Programa de Vacunas para Niños (VFC) y reciban vacunas adquiridas a nivel federal sin costo.

How to fill out vaccines for children vfc

How to fill out VACCINES FOR CHILDREN (VFC) PROGRAM PROVIDER ENROLLMENT FORM

1. Obtain the VFC Program Provider Enrollment Form from your local health department or the VFC website.
2. Complete the provider information section with your facility's name, address, and contact details.
3. Fill out the provider type and specialization, indicating if you serve children.
4. Provide the names and contact information of all healthcare providers at your facility who will be administering vaccines.
5. Indicate your facility’s hours of operation and the methods of vaccine administration.
6. Ensure you review and understand the VFC program requirements outlined in the instructions.
7. Sign and date the enrollment form, verifying the accuracy of the provided information.
8. Submit the completed enrollment form to your local health department or designated VFC coordinator.

Who needs VACCINES FOR CHILDREN (VFC) PROGRAM PROVIDER ENROLLMENT FORM?

1. Healthcare providers who administer vaccines to children and seek to participate in the VFC program.
2. Clinics and practices that serve uninsured, underinsured, and Medicaid-eligible children.
3. Hospitals and health systems that offer vaccination services for pediatric patients.

People Also Ask about

Who is eligible to receive this vaccination?

After only 24 days in office, President Bill Clinton announced a comprehensive childhood immunization initiative designed to assure that all children in the United States lead healthier lives by receiving age-appropriate immunizations against preventable diseases such as polio, mumps, measles, whooping cough, and

How to qualify for Vaccines for Children program?

Medicaid eligible: A child who is eligible for (or enrolled in) the Medicaid program. CHIP enrollees within a Medicaid expansion program: A child who is enrolled in a Children's Health Insurance Program (CHIP) that is part of an expanded Medicaid program. Uninsured: A child who has no health insurance coverage.

What are the requirements for VFC vaccine documentation?

In ance with federal law, VFC providers must maintain immunization records that include ALL of the following elements: (1) name of vaccine administered; (2) date vaccine was administered; (3) date VIS was given; (4) publication date of VIS; (5) name of vaccine manufacturer; (6) vaccine lot number; (7) name and

What vaccines are covered under the VFC program?

Vaccines covered through the VFC Program COVID-19. Dengue. Diphtheria. Haemophilus influenzae type b (Hib) Hepatitis A. Hepatitis B. Human Papillomavirus (HPV) Influenza (flu)

Who is eligible for the vaccines for children program?

CDC recommends a 2024-2025 COVID-19 vaccine for most adults ages 18 and older. Parents of children ages 6 months to 17 years should discuss the benefits of vaccination with a healthcare provider. The COVID-19 vaccine helps protect you from severe illness, hospitalization, and death.

How to bill for VFC vaccines?

VFC-funded vaccine claims for the immunization administration fee can be submitted as a pharmacy claim through Medi-Cal Rx for both Medi-Cal fee-for-service (FFS) and managed care plan (MCP) members, or as a medical claim to either DHCS (CA-MMIS) for FFS members, or to the MCP's medical benefit for MCP members.

What is the childhood immunization initiative program?

The Vaccines for Children (VFC) Program helps families by providing vaccines at no cost to medical providers who serve eligible children from birth through 18 years of age. CDC contracts with vaccine manufacturers to buy vaccines at reduced rates.

For pdfFiller’s FAQs

What is VACCINES FOR CHILDREN (VFC) PROGRAM PROVIDER ENROLLMENT FORM?

The VACCINES FOR CHILDREN (VFC) PROGRAM PROVIDER ENROLLMENT FORM is a document that healthcare providers must complete to participate in the VFC program, which provides free vaccines to eligible children.

Who is required to file VACCINES FOR CHILDREN (VFC) PROGRAM PROVIDER ENROLLMENT FORM?

Healthcare providers who wish to enroll in the VFC program and administer vaccines to eligible children are required to file the VFC PROGRAM PROVIDER ENROLLMENT FORM.

How to fill out VACCINES FOR CHILDREN (VFC) PROGRAM PROVIDER ENROLLMENT FORM?

To fill out the VFC PROGRAM PROVIDER ENROLLMENT FORM, providers need to provide their facility information, details about the provider and staff, clinic hours, and patient population served, along with signing and dating the form.

What is the purpose of VACCINES FOR CHILDREN (VFC) PROGRAM PROVIDER ENROLLMENT FORM?

The purpose of the VFC PROGRAM PROVIDER ENROLLMENT FORM is to establish eligibility for healthcare providers to receive and administer vaccines at no cost to children who meet certain income and insurance criteria.

What information must be reported on VACCINES FOR CHILDREN (VFC) PROGRAM PROVIDER ENROLLMENT FORM?

The information that must be reported includes the provider's name, practice location, contact information, clinical staff details, types of vaccines administered, and any other relevant details about the practice and patient demographics.