Immunization Program

Immunization Provider Forms
Immunization Forms/Materials	Immunization Schedules
Certificate of Immunizations	CDC
Influenza Vaccine Order Form	2013 Immunization Schedule (0-18 years)
Materials Order Form	2013 Immunization Schedule (Adults)
Vaccine Administration Monthly Report	2013 Catch-Up Schedule
Vaccine Administration Monthly Report (Family Planning)
Vaccine Administration Record
Vaccine Administration Record (Family Planning)	NDDoH
Vaccine Coverage Table^updated	S chedule Using Pediarix
Vaccine Return and Wastage Form^updated	Schedule Using Pentacel
Vaccine Transfer Form^updated
VFC Vaccine Borrow/Return Form^updated
VFC Patient Screening Record
VIS - Vaccine Information Statements

Vaccine Specific Information	Provider Enrollment
2012-2013 Influenza Vaccine Dosage Chart	Prevention Partnership Enrollment Forms
2012-2013 Influenza Vaccine Algorithm	Enrollment Agreement ^updated
Using Pentacel and Pediarix	Provider Profile ^updated
Hib Vaccination Algorithm	Vaccine Storage Certification^updated
PCV-13 Recommendations
Varicella Vaccination Algorithm
Pentacel to Pediarix Transition

Program Policies	Temperature Monitoring
Vaccine Management Plan Template ^updated	Celsius Only
Fraud and Abuse Policy ^updated	Fahrenheit Only
North Dakota Vaccine Loss Policy ^updated	Fahrenheit Refrigerator/Celsius Freezer
VFC Questions and Answers ^updated	"Do Not Unplug" Circuit Breaker Sign
NDDoH Vaccine Management Policy ^UPDATED	"Do Not Unplug" Electrical Outlet Sign
	Vaccine Manufacturers' Phone Numbers
	Guidance for Purchasing Thermometers

Patient Materials	International Travel
Pertussis Isn't Just for Babies!	International Travel Risk Assessment
Be Wise - Immunize Activity Book	International Travel Health Kit
Vaccine Safety Fact Sheet	Traveling Internationally While Pregnant
	International Travel for Humanitarians

Vaccine Adverse Event Reporting System (VAERS)
VAERS Website