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VFC Providers
ISDH Immunization Staff Directory Maps
- Regional Quality Assurance and Vaccine Ordering and Accountability Combined Team Map-Dec 2019
- Regional Vaccine Ordering and Accountability Team Map-Dec 2019
Indiana Policies and Procedures
- 2018 Publicly Funded Vaccine Programs Policies and Procedures Manual
- 2020 Vaccine Management Plan
- Policy 1: Provider Eligibility for Vaccines for Publicly Funded Vaccine Programs
- Policy 2: Childhood Vaccine Eligibility Statement
- Policy 3: Adult Eligibility Policy
- Policy 4: New Provider Enrollment
- Policy 5: Provider Agreement Dissolution
- Policy 6: Vaccine Coordinator
- Policy 7: Storage and Handling - Vaccine Management
- Policy 8: Storage and Handling - Storage Unit Requirements
- Policy 9: Storage and Handling - Temperature Requirements
- Policy 10: Storage and Handling - Emergency Plans
- Policy 11: Storage and Handling - Cold Chain Failure
- Policy 12: Storage and Handling - Transporting to Off-Site Clinics
- Policy 13: Vaccine Order Management - Provider Orders
- Policy 14: Publicly Funded Vaccine Accountability
- Policy 15: Immunization Information System (IIS) Requirements
- Policy 16: Loss, Wastage, and Reimbursement
- Policy 17: Provider Vaccine Returns
- Policy 18: Borrowing Vaccine
- Policy 19: Vaccine Transfers
- Policy 20: Fraud and Abuse
- Policy 21: CHIRP Record Inactivation
- Policy 22: Administration of Mishandled Vaccines
- Policy 23: Vaccine Administration
VFC Forms & Quick Reference Guides
Patient Eligibility Screening Resources
Forms to support VFC-enrolled providers in ensuring VFC elibility screening takes place with each immunization visit for all patients.
- Patient Eligibility Screening Record (State Form 48514)
- Patient Eligibility Screening Record - Spanish (State Form 55674)
Vaccine Inventory & Wastage Forms
Forms to support VFC-enrolled providers in managing and maintaining adequate inventory of vaccine for both VFC eligible and non-VFC eligible patients.
- Vaccine Return Form (State Form 54042)
- Vaccine Transfer Report (State Form 54658)
- Vaccine Borrowing Report
- Vaccine Restitution Report
- Vaccine Special Order Form
- Vaccine Tracking Log
Enrollment & Disenrollment
- Immunization Provider Contact Request Form
Email the completed form to enrollments@isdh.in.gov or fax to (317) 233-3719. - Provider Disenrollment
Off-Site Clinic Forms
- Off-Site Clinic Checklist
- Influenza Clinic Consent Form
- School Immunization Clinic Consent Form
Adolescent vaccines only - School Immunization Clinic Consent Form
All ages
CHIRP Quick Reference Guides
- Adding Adverse Reactions
- Adding Vaccinators and Physicians
- CHIRP Lot Decrement Cheat Sheet
- Coverage Rate Reports
- Finding Non-Decrementing Doses using the Patient Detail Report
- How to Report Duplicate Patients
- IIS Organization and Facility Structure
- Lot Usage and Recall Report
- MyVaxIndiana Reference Guide
- Reminder Recall-Quick Reference Guide
- User Accounts and Passwords
- Vaccine Doses Administered Report
- VFC Ordering in CHIRP
Storage and Handling
2020 CDC Storage and Handling Toolkit (NEW: January 2020)
Data Loggers
- Indiana State Department of Health VFC Program Data Logger Guide
- American Academy of Pediatrics Data Loggers Buyer's Guide
Storage Units and Equipment
- Indiana VFC Storage Unit Requirements
- American Academy of Pediatrics Storage Unit Buyer's Guide
- Portable Vaccine Refrigerators and Freezer Guide (FridgeFreeze)
- Transport Cooler Guide
- Warning and Do Not Unplug Labels
Temperature Logs
- Refrigerator with Min-Max (1 month)
- Freezer with Min-Max (1 month)
- Fridge-Freeze with Min-Max (1 month)
- Refrigerator and Freezer (for 12 hour clinic day)
Vaccine Order Management System (VOMS)
Please visit the CHIRP VOMS page for VOMS paperwork and information.
Contact your field representative, educator, or the Immunization Division for more information. You can send an email to immunize@isdh.in.gov or call the toll free number at (800) 701-0704.