Provider Policies - Adult Safety Net Program


Storage and Handling of Adult Safety Net Program (ASN) Vaccines

Providers must adhere to the vaccine storage and handling guidelines as required by the Texas Vaccines for Children (TVFC) program and the Centers for Disease Control and Prevention (CDC).


Administering ASN Program Vaccines

Providers enrolled in the ASN program must adhere to the following requirements.

  • Providers must screen patients for eligibility during each encounter by using the official Adult Eligibility Screening Record (Publication EF11-12842), which may be found on the Forms and Publications page of this website.
  • Completed copies of the Adult Eligibility Screening Record (Publication EF11-12842) must be kept on file for five years and be made available upon request from DSHS or a Local Health Department to ensure program accountability and client eligibility.
  • Providers cannot charge for the cost of the vaccine.
  • Patients may be charged an administration fee of up to $25 for each dose that is administered. It is important to note that if a client is unable to pay for the administration fee, the provider cannot deny the vaccine to the client.

Promotion of the ASN Program/Off-site Clinics

Provider sites who are enrolled in the ASN Program may promote the availability of these vaccines to potential clients. Additionally, providers may conduct off-site, mobile vaccination clinics that offer ASN Program vaccine, as long as the following requirements are met:

  • Vaccines are only offered to uninsured adults.
  • The official Adult Eligibility Screening Record (Publication EF11-12842) must be used to screen all clients prior to vaccination and the forms shall be kept on record for a period of five years. Publications may be downloaded from the Forms and Publications page of this website.
  • TVFC Program vaccine storage and handling guidelines are followed.
Last updated February 3, 2017