Forms
This form should be used as Consent for COVID-19 Vaccinations
This form should be used to report out of range temperature incidents and submit a troubleshooting record to the vaccines for children program.
Colfax, Guadalupe, Harding, Los Alamos, Mora, Rio Arriba, San Miguel, Santa Fe, Taos, and Union
Cibola, McKinley, San Juan, Sandoval, Torrance, and Valencia
Chaves, Curry, DeBaca, Lincoln, and Quay
Eddy, Lea, Lincoln, and Roosevelt
Catron, Dona Ana, Grant, Hidalgo, Luna, Otero, Sierra, and Socorro
Complete this log when transporting vaccines to an alternate or back-up refrigerator, or when transferring to another provider.