Get the free VFC Provider Profile Form - cdph ca

This document provides guidelines for VFC providers to estimate the number of vaccine doses administered and the eligibility of children for the VFC Program. It includes tables for recording doses,

How to fill out vfc provider profile form

How to fill out VFC Provider Profile Form

1. Download the VFC Provider Profile Form from the official VFC website.
2. Fill in the provider's name and contact information in the designated fields.
3. Provide the facility information, including address and phone number.
4. Indicate the type of facility (e.g., private practice, clinic, health department).
5. List the services offered by your facility that relate to vaccination.
6. Specify the number of eligible patients served annually.
7. Complete the sections about vaccine storage and handling procedures.
8. Include the names and positions of the healthcare staff who will be administering vaccines.
9. Review the form for accuracy and completeness before submitting.
10. Submit the completed form to the appropriate VFC program office.

Who needs VFC Provider Profile Form?

1. Healthcare providers who wish to participate in the Vaccines for Children (VFC) program.
2. Clinics and healthcare facilities that provide immunization services to eligible children.
3. Any organization looking to obtain VFC vaccines for low-income children.

People Also Ask about

What three VFC roles are required at every VFC site?

Each site is required to have the following roles: 1. Primary Coordinator 2. Back-Up Coordinator 3. Medical Director or Equivalent (Physician Signing Agreement) This person is responsible for overall compliance.

How much does the VFC Program cost?

VFC Program vaccines are free, but the law allows your healthcare provider to charge an administration fee. This fee is like a patient's copay; it helps providers offset their costs of giving the vaccine to your child.

What are the requirements for meaningful use documentation?

To fulfill the requirements for Meaningful Use, eligible professionals must successfully complete the 3 main components of the program: 1) use certified EHR, 2) meet core and menu set objectives, and 3) report clinical quality measures.

What constitutes sufficient documentation for vaccine counseling?

The documentation should include: A statement that vaccine counseling was provided and performed by the physician or other qualified health care professional. Include notation that counseling was completed for all vaccine components administered.

What are the requirements for VFC 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 is a VFC provider?

The Vaccines for Children (VFC) Program helps families by providing vaccines at no cost to providers who serve eligible children from birth through 18 years of age. Enroll your organization.

What are considered VFC program records?

A record of all children 18 years of age or younger who receive immunizations must be kept in the health care provider's office for 3 years or longer depending on state law. The record may be completed by the parent, guardian, individual of record, or by the health care provider.

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

For pdfFiller’s FAQs

What is VFC Provider Profile Form?

The VFC Provider Profile Form is a document used by healthcare providers participating in the Vaccines for Children (VFC) program to provide necessary information about their practice and ensure compliance with VFC guidelines.

Who is required to file VFC Provider Profile Form?

Healthcare providers who wish to enroll in the VFC program or continue their participation must file the VFC Provider Profile Form.

How to fill out VFC Provider Profile Form?

To fill out the VFC Provider Profile Form, healthcare providers should gather the required information about their practice, including immunization storage capacity, staff training, and patient demographics, and then complete the form accurately as per the provided instructions.

What is the purpose of VFC Provider Profile Form?

The purpose of the VFC Provider Profile Form is to collect essential information that ensures participating providers meet program requirements and can safely store and administer vaccines to eligible children.

What information must be reported on VFC Provider Profile Form?

The VFC Provider Profile Form requires reporting information such as provider contact details, immunization storage and handling practices, the number of children served, and staff training and qualification details.