Follow the steps to accurately fill out the VFC Patient Eligibility Screening Form.

1. Click 'Get Form' button to obtain the form and open it in the editor.
2. Begin by entering the patient’s name in the designated field at the top of the form. Ensure that the name is written clearly and accurately spelled.
3. Next, fill in the date of birth for the patient. This is crucial for determining eligibility based on age.
4. Record the date when the patient was first screened. This helps keep track of the patient’s vaccination history.
5. Indicate if the patient is NOT eligible today for one of the specified reasons by checking the appropriate box. Options include coverage by third-party insurance or being underinsured.
6. If the patient is eligible, check the corresponding box for the reason. This includes options such as enrolled in TennCare (Medicaid), uninsured, American Indian/Alaskan Native, or underinsured.
7. For the screening updates section, enter the date the new information was screened along with the eligibility status, checking only one category.
8. Once all sections are filled out, review the information for accuracy. Consider saving a copy for your records.
9. To complete the process, you can download, print, or share the form as needed.

Start filling out the VFC Patient Eligibility Screening Form online today to ensure the patient receives the necessary vaccinations.