Get Nm Vfc Vaccine Administration Form 2023-2025

The NM VFC Vaccine Administration Form is an essential document for documenting the administration of vaccines. This guide provides clear, step-by-step instructions on filling out the form online, ensuring that users complete it accurately and efficiently.

Follow the steps to complete the NM VFC Vaccine Administration Form online

1. Click ‘Get Form’ button to access the NM VFC Vaccine Administration Form and open it for editing.
2. Begin filling in the required fields for the person receiving the vaccine. Ensure that each entry is written in all capitals, including the last name, first name, and mother's maiden name.
3. Enter the date of birth in the specified format (month/day/year) along with the mailing address, city, and phone numbers. Make sure to provide the sex of the individual, selecting one of the provided options.
4. Provide the mother’s first name, state (always NM), zip code, race, and email. You may also indicate preferences for vaccine reminders.
5. In the insurance information section, mark the appropriate category and provide details such as Medicaid plan, Centennial Care Card ID, or private insurance information, depending on the user's coverage.
6. Answer the medical screening questions for children and teens completely. Responses to each question will assist healthcare providers in determining vaccine eligibility.
7. In the consent section, ensure that the client or guardian reads the vaccine information statement, questions are answered satisfactorily, and sign the document by providing their signature, print name, and date.
8. Fill in the details for the vaccines administered in the clinic use section, including vaccine type, date administered, site, and funding information.
9. Finally, review all entries for accuracy. Once confirmed, users can save changes, download the completed form, print it, or share as necessary.

Complete your NM VFC Vaccine Administration Form online today.