Forms & Publications - Texas Vaccines for Children

Table of Contents

TVFC Forms

Resources and Training

Manuals and Forms

Provider Manual

2018 Texas Vaccine for Children and Adult Safety Net Provider Manual
Full Manual
2018 TVFC and ASN Provider Manual (PDF) 10/2017

2017 Texas Vaccines for Children Provider Manual

2017 Texas Vaccines for Children Provider Manual
Section Title Revision Date
Introduction Introduction to the Provider Manual and the TVFC Program (PDF) 08/2017
Chapter 1 Provider Eligibility and Enrollment (PDF) 08/2017
Chapter 2 Patient Eligibility and Screening (PDF) 08/2017
Chapter 3 Vaccine Management (PDF) 08/2017
Chapter 4 Billing and Administration (PDF) 08/2017
Chapter 5 Program Evaluation (PDF) 08/2017
Chapter 6 Fraud and Abuse (PDF) 08/2017
Chapter 7 Documentation Requirements (PDF) 08/2017
Chapter 8 Adult Safety Net (ASN) Program (PDF) 08/2017
Chapter 9 Vaccine Information Statements (VIS) (PDF) 08/2017
Chapter 10 Ordering Forms and Literature (PDF) 08/2017
Chapter 11 Immunization Resources (PDF) 08/2017
Changelog Summary of Changes and Updates (PDF) 08/2017
Full Manual Texas Vaccines for Children Program - Provider Manual (PDF) 08/2017

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) 06/2017
C-88 Combined Tally and Physical Inventory (XLS) 02/2012
E11-11190 Vaccine Management Plan Templates (PDF) 08/2016
E11-14497 Emergency Vaccine Storage and Handling Plan Checklist (PDF) 01/2015
EC-67 Vaccine Transfer Authorization Form (PDF) 01/2017
EC-105-FC Temperature Recording Form (Freezer-Celsius) (PDF) 10/2016
EC-105-FF Temperature Recording Form (Freezer - Fahrenheit) (PDF) 08/2016
EC-105-RC Temperature Recording Form (Refrigerator-Celsius) (PDF) 08/2016
EC-105-RF Temperature Recording Form (Refrigerator-Fahrenheit) (PDF) 08/2016
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) 08/2016
EF11-12842 Adult Eligibility Screening Record (Bilingual) (PDF) 08/2016
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) 07/2016
New Provider Enrollment Checklist 11/2017 

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 (PDF) 10/2017
E11-14482 Best Practices Frozen Vaccines (PDF) 10/2014
E11-14484 Vaccine Temperature Best Practices Fridge (PDF) 10/2017
E11-14483 Vaccine Temperature Best Practices Frozen (PDF) 10/2014


Last updated November 27, 2017