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Forms


Photo of the publication cover. VFC Metro Region Temperature Log Form Immunization - Form October 23, 2023

County: Bernalillo



Photo of the publication cover. VFC Northeast Region Temperature Log Form Immunization - Form October 23, 2023

Colfax, Guadalupe, Harding, Los Alamos, Mora, Rio Arriba, San Miguel, Santa Fe, Taos, and Union



Photo of the publication cover. VFC Southwest Region Temperature Log Form Immunization - Form October 23, 2023

Catron, Dona Ana, Grant, Hidalgo, Luna, Otero, Sierra, and Socorro



Photo of the publication cover. VFC Routine Vaccine Management Plan Immunization - Form October 23, 2023

The New Mexico VFC Program requires each practice to develop and maintain a Routine Vaccine Management Plan. Properly completing this template will meet the VFC Program requirement for VFC Program participants to have written vaccine storage and handling plans.



Photo of the publication cover. VFC Emergency Vaccine Management Plan Immunization - Form October 23, 2023

The New Mexico VFC Program requires each practice to develop and maintain an Emergency Vaccine Management Plan. Properly completing this template will meet the VFC Program requirement to have a written plan for storage and handling procedures in an emergency.



Photo of the publication cover. Adult TSR Form Immunization - Form August 11, 2023

Adult TSR Form



Photo of the publication cover. VFC Provider Staff Change of Contact and uploading Training Immunization - Form April 13, 2023

VFC Provider Staff Change of Contact and uploading Training



Photo of the publication cover. VFC Physician Signing Agreement Change of Contact Immunization - Form April 13, 2023

VFC Physician Signing Agreement Change of Contact



Photo of the publication cover. VFC New Provider Application Immunization - Form April 13, 2023

All VFC providers are required to submit this annual VFC certification form in order to continue receiving VFC vaccines.

VFC Instructions on Digital Signature and Attaching License



Photo of the publication cover. VFC Provider NM Health Passport Order Form Immunization - Form April 13, 2023

This form allows providers to order VFC supplies.



Photo of the publication cover. NMSIIS Organization Security and Confidentiality Agreement 2023 Immunization - Form January 3, 2023

Participant organization security and confidentiality agreement for the New Mexico Statewide Immunization Information System.



Photo of the publication cover. NMSIIS User Security and Confidentiality Agreement 2023 Immunization - Form January 3, 2023

NMSIIS User Security and Confidentiality Agreement 2023