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Texas Vaccines for Children Information for Parents Provider Enrollment Current TVFC Providers Policy Memo Updates Provider Manual Forms & Publications Yellow Fever Information Rabies Biologicals Available TVFC Vaccines Electronic Vaccine Inventory (EVI) Login TVFC Flu Program

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Forms & Publications - Texas Vaccines for Children

Table of Contents

TVFC Forms

Texas Vaccines for Children Provider Manual
Vaccine Inventory, Storage, and Reporting
Patient Eligibility / Referral
Provider Enrollment and Withdrawal

Resources and Training

Vaccine Storage and Handling Resources
Underinsured Survey 2020 NOTE: This link will be removed on Jan. 31, 2021. The Underinsured reporting due on Jan. 15 is required to be entered into the 2020 survey.
Underinsured Survey 2021
Vaccine Adverse Event Reporting System (VAERS) CDC Website and Submission Form

Manuals and Forms

Provider Manual

Texas Vaccine for Children and Adult Safety Net Provider Manual
11-13602	2021 TVFC and ASN Provider Manual (PDF)	1/2021

Vaccine Inventory, Storage, and Reporting

Texas Vaccines for Children Publications Related to Vaccine Inventory, Storage, and Reporting
Stock Number	Title	Revision Date
C-33	Monthly Biological Report (PDF)	01/2017
EC-68-1	Pediatric Biological Order Form (PDF)	12/2020
C-88	Combined Tally and Physical Inventory (XLS)	02/2012
E11-14498	Vaccine Management Plan Templates	11/2019
EC-67	Vaccine Transfer Authorization Form (PDF)	01/2017
EC-105-FC	Temperature Recording Form (Freezer-Celsius) (PDF)	09/2020
EC-105-FF	Temperature Recording Form (Freezer - Fahrenheit) (PDF)	09/2020
EC-105-RC	Temperature Recording Form (Refrigerator-Celsius) (PDF)	09/2020
EC-105-RF	Temperature Recording Form (Refrigerator-Fahrenheit) (PDF)	09/2020
EF11-14171	Vaccine Borrowing Form (PDF)	12/2016

Patient Eligibility / Referral

Texas Vaccines for Children Publications Related to Patient Eligibility, Screening, and Referral
Stock Number	Title	Revision Date
C-10	Patient Eligibility Screening Record (Bilingual) (PDF)	05/2017
EF11-13788	Patient Referral Form for Vaccination From Local Health Department or Public Health Clinic (PDF)	08/2016
EF11-13789	TVFC Patient Screening Decision Tree (PDF)	12/2011

Provider Enrollment and Withdrawal

Texas Vaccines for Children Publications Related to Provider Enrollment and Withdrawal
Stock Number	Title	Revision Date
Online Form	Provider Agreement Form	NA
F11-11443	Provider Withdrawal Form (PDF)	09/2020
11-15016	New Enrollment Checklist	10/2020
11-15224	Changes to Enrollment Form (PDF)	09/2020

Resources and Training

Vaccine Storage and Handling Resources

Vaccine Storage and Handling Resources
Stock Number	Title	Revision Date
E11-13605	Storage Calculation Tool Instructions (PDF)	05/2010
EF11-13613	Storage Calculation Tool (XLS)	05/2010
E11-14481	Best Practices Refrigerated Vaccines F/C (PDF)	07/2019
E11-14482	Best Practices Frozen Vaccines F/C (PDF)	07/2019
E11-14484	Vaccine Temperature Best Practices Fridge F/C (PDF)	07/2019
E11-14483	Vaccine Temperature Best Practices Frozen F/C (PDF)	07/2019

Last updated January 20, 2021