Forms & Publications - Texas Vaccines for Children


Table of Contents

TVFC Forms

Reporting

Resources and Training


Manuals and Forms

Texas Vaccine for Children and Adult Safety Net Provider Manual

Stock Number Title Revision Date
11-13602 2024 TVFC and ASN Provider Manual (PDF) 2/2024

Vaccine Inventory, Storage, and Reporting

Stock Number Title Revision Date
C-88 Combined Tally and Physical Inventory (XLS) 02/2012
E11-14498 Vaccine Management Plan Templates 02/2022
EC-67 Vaccine Transfer Authorization Form (PDF) 03/2022
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) 05/2023

Patient Eligibility / 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

Stock Number Title Revision Date
F11-11443 Provider Withdrawal Form (PDF) 05/2023
11-15016 New Enrollment Checklist 03/2022
11-15224 Changes to Enrollment Form (PDF) 04/2022

Resources and Training

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