Get the free Patient VFC Status Screening Form - Washington State Department ... - doh wa

Washington State Department of Health Office of Immunization and Child Profile Patient AFC Status Screening Form Child's Full Name: Date of Birth: Full name of Parent, Guardian, or Legal Representative:

How to fill out patient vfc status screening

How to fill out patient VFC status screening:

1. Begin by accessing the patient VFC status screening form.
2. Provide the patient's personal information, such as their full name, date of birth, and contact details.
3. Indicate the patient's current vaccination status by checking the appropriate boxes or selecting from the provided options.
4. If the patient has received any vaccinations, specify the type(s) and the date(s) they were administered.
5. If the patient has not received any vaccinations or their vaccination status is unknown, provide the reason or explanation in the designated area.
6. Answer any additional questions on the form regarding the patient's eligibility for the VFC program or their need for certain vaccines.
7. Review the completed form for accuracy and make any necessary corrections.
8. Sign and date the form, confirming that the information provided is true and accurate.
9. Submit the completed patient VFC status screening form to the appropriate healthcare provider or agency.

Who needs patient VFC status screening:

1. The patient VFC status screening is typically required for children and adolescents who are eligible for the Vaccines for Children (VFC) program.
2. Individuals who are uninsured, underinsured, Medicaid-eligible, or American Indian/Alaska Native may also need to undergo VFC status screening.
3. Patients who receive healthcare services from VFC-enrolled facilities or healthcare providers may be required to go through the VFC status screening process.

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