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  • (vfc) Program Provider Profile Form Supplemental - California ... - Cdph Ca

Get (vfc) Program Provider Profile Form Supplemental - California ... - Cdph Ca

State of California Health and Human Services Agency Department of Health Services VACCINES FOR CHILDREN (VFC) PROGRAM PROVIDER PROFILE FORM SUPPLEMENTAL COUNTY NAME OF PHYSICIAN S OFFICE, PRACTICE,.

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By law, the following information must be documented on the patient's paper or electronic medical record (or on a permanent office log): The vaccine manufacturer. The lot number of the vaccine. The date the vaccine is administered.

VFC providers are required to maintain all records related to the VFC program for a minimum of three years (or longer if required by state law) and upon request make these records available for review.

The provider agreement describes VFC program requirements and is used to document the provider's agreement to comply with the requirements. It must be signed annually by the medical director (or equivalent) in a group practice.

Enrollment into the VFC Program is done via MCIR. New providers can complete an online enrollment by accessing the Enroll in VFC Program link from their MCIR home page. Once the form is completely filled out they must submit the form, which goes to the local health department for their county.

How often should the provider profile form and provider agreement form be completed and submitted to your state or local immunization program? At minimum, vaccine management plans and standard operating procedures should be reviewed once a year.

What are the Costs or Fees? There is no charge for any vaccines given by a VFC provider to eligible children.

Who can be a VFC provider? Any California-licensed M.D., D.O., or health care organization serving VFC-eligible children can become a VFC provider. The VFC Program has earned high marks from California doctors for making it easy to provide high quality care to their patients.

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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232