Vfc Vaccine Usage Worksheet Form PDF Details

Navigating the landscape of childhood immunizations can be complex, but the Florida Vaccines for Children (VFC) Program Vaccine Usage Worksheet offers a structured approach to ensure all children, regardless of their financial situation, have access to essential vaccinations. This vital tool helps healthcare providers record the immunization status of children according to various factors such as age, VFC eligibility, and the type of vaccine administered. Specifically, the form allows for detailed documentation across different age groups—ranging from babies under one year to adolescents up to 18 years—and categorizes patients based on Medicaid status, lack of insurance, underinsurance, and whether they're of American Indian or Alaskan Native heritage. With sections dedicated to a comprehensive list of vaccines, including DTaP, Hepatitis A and B, HPV, and flu shots among others, the worksheet ensures no child is left behind in their vaccination schedule. Moreover, the form plays a crucial role in public health by facilitating an accurate tally of immunized children, thus aiding the Florida Department of Health's Bureau of Immunization in their efforts to protect all children from vaccine-preventable diseases.

QuestionAnswer
Form NameVfc Vaccine Usage Worksheet Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesflorida vaccine for children vaccine usage worksheet, vaccine usage worksheet get, vaccine usage waste worksheet, how to register senior for vaccine in fl

Form Preview Example

Florida Vaccines for Children (VFC) Program

Vaccine Usage Worksheet

PIN #:_____________

AB

 

 

 

<1 YEAR

 

 

 

 

NoInsurance

Underinsured

Native

Patient ID

Date

Medicaid

Am.Indian/AK

 

Shot

 

 

 

 

Totals

* Check below the appropriate box for eligibility and vaccines.

 

 

 

 

 

 

 

C

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VFC Eligibility*

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1-6 YEARS

7-10 YEARS

11-12 YEARS

13-18 YEARS

 

 

 

 

 

 

 

 

 

Vaccines*

 

 

 

 

 

 

 

 

 

Medicaid

 

No Insurance

Underinsured

Am. Indian/AK Native

Medicaid

No Insurance

 

Underinsured

Am. Indian/AK Native

Medicaid

No Insurance

Underinsured

Am. Indian/AK Native

Medicaid

No Insurance

Underinsured

Am. Indian/AK Native

DTaP

DTaP/Hep B/IPV

Kinrix

Pentacel

Hep A

Hep B

Hep B/Hib

Hib

HPV

EIPV (Polio)

Meningococcal

 

MMR

PCV-7

Rotavirus

Rotarix

Td

Tdap

Flu (0.25ml)

Flu (0.50mi)

FluMist

Varicella

MMRV

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Record the total number of children immunized

by age and VFC eligibility

Medicaid

No Insurance

Underinsured

American Indian/Alaskan Native

TOTAL CHILDREN IMMUNIZED

E

F

G

H

I

<1 YEAR

1-6 YEARS

7-10 YEARS

11-12 YEARS

13-18 YEARS

 

 

 

 

 

Mailing Adrress:

FL Department of Health

Bureau of Immunization

4052 Bald Cypress Way, Bin A-11

Tallahassee, Florida 32399-1700

Fax: (850) 245-4734

Phone: 1-800-483-2543

Revised September 2008