Provider & Eligibility Forms

• Eligibility Form - English
• Eligibility Form - Spanish
• Provider Profile and Enrollment Form

Report Forms

• Doses Administered Access
• Doses Administered User Instructions

Storage & Handling Forms

• Emergency Response Worksheet
• Temperature Log (C)
• Temperature Log (F)
• Training Quiz & Checklist
• Vaccine Handling Plans Template
• Vaccine Storage & Handling Guide
• Vaccine Spoilage Checklist

Tally Sheets

• CHIP Tally Sheet
• FQHC/RHC Tally Sheet (if your PIN begins with "F")
• Special Project Tally Sheet
• Under-Insured Tally Sheet
• VFC Tally Sheet (for all ages)

Vaccine Forms

• Influenza Vaccine Order Form
• Vaccine Administration Record
• Vaccine Inventory Form
• Vaccine Order Form
• Vaccine Return and Transfer Form

USIIS Forms and Manuals

• New User / Security Agreement
• Provider Enrollment Packet
• Quick Reference Guide for Users
• Vaccine Code List

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