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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 Vaccine Management Resources 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

Reporting

Underinsured Survey 2022

Resources and Training

Manuals and Forms

Provider Manual

Texas Vaccine for Children and Adult Safety Net Provider Manual
11-13602	2022 TVFC and ASN Provider Manual (PDF)	3/2022

Vaccine Inventory, Storage, and Reporting

Texas Vaccines for Children Publications Related to 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	11/2021
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)	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
F11-11443	Provider Withdrawal Form (PDF)	04/2022
11-15016	New Enrollment Checklist	03/2022
11-15224	Changes to Enrollment Form (PDF)	04/2022

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 May 26, 2022