Get Nm Vfc Immunization Consent Form

The Nm Vfc Immunization Consent Form is a crucial document for obtaining vaccinations for children. This guide will walk you through the steps to complete the form online, ensuring you have all necessary information at hand.

Follow the steps to successfully complete the form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling in the personal details of the person receiving the vaccine. Start with 'Last Name,' 'First Name,' and 'Middle Initial.' Ensure accuracy when entering the 'Date of Birth' and 'Child’s Age.' Include 'Mother’s Maiden Name' and 'Mother’s First Name.'
3. Select the 'Sex' of the individual from the provided options: Male or Female. Then, indicate their 'Ethnicity' by selecting either Hispanic or Non-Hispanic.
4. Fill in the 'Mailing Address' along with the 'City,' 'State,' and 'Zip' code. Provide the 'Race' by selecting from the options given.
5. In the 'Insurance Status' section, mark the appropriate category for children aged 0–18 years. Choose from options such as Private/Commercial insurance or No health insurance, and indicate if they are American Indian.
6. For each insurance plan, place a check mark next to the applicable provider, if any. Ensure that the 'Policy #' and 'Medicaid Salud #' are filled in accurately if applicable.
7. Read the acknowledgment statement carefully. Confirm that you have received and understood the 'Vaccine Information Statement(s)' for the vaccines you are requesting.
8. Sign the form as the parent or guardian. Enter your signature in the designated field along with today's date.
9. For the school nurse's use section, ensure that the school name and VFC Pin number are noted down by the school nurse after the form is reviewed.
10. Once all fields are completed, save your changes. You can then download, print, or share the form as needed.

Complete your forms online with confidence and ensure your child's vaccinations are scheduled!