Get New Mexico Vfc Vaccine Administration Form

The New Mexico VFC Vaccine Administration Form is essential for documenting vaccine administration. This guide provides clear instructions to help users complete this form online accurately and efficiently.

Follow the steps to fill out the form correctly.

1. Press the ‘Get Form’ button to access the document. This action will open the form in an editable format, allowing you to begin filling it out.
2. Begin by entering the information for the person receiving the vaccine. Print clearly in all capitals for fields marked with an asterisk. Fill in the last name, first name, middle initial, date of birth, sex, and mother’s maiden name.
3. Provide additional details for the person's ethnicity and race by selecting the appropriate options provided in the form.
4. Fill in the mailing address, including the city, state, and zip code. Enter both the cell phone and home phone numbers, as well as the email address of the person receiving the vaccine.
5. Identify the responsible person for the vaccine recipient by entering their last name and first name. Clearly state their relationship to the individual receiving the vaccine.
6. Sign in the signature field, indicating consent to receive vaccine reminders through various communication methods.
7. Indicate the insurance status by marking the appropriate category. If the person has private or commercial insurance, include the insurance company's name and policy number.
8. Complete the clinic use section with the required documentation, including vaccine, manufacturer, lot number, and other pertinent details.
9. Once the form is fully completed, save your changes. You can then download, print, or share the form as needed.

Start filling out the New Mexico VFC Vaccine Administration Form online to ensure proper vaccine documentation.