Medical Providers Forms

   2010 Adult Immunization Schedule (CDC) (ID=136)

   2010 Childhood Immunization Schedule (CDC) (ID=135)

   2010 Childhood Immunization Schedule (NDDoH) (ID=160)

   2010 Fraud and Abuse Policy (ID=256)

   2010 Recommended IHS Childhood Immunization Schedule (NDDoH) (ID=161)

   2010 Vaccine Loss Policy (ID=257)

   Adult Tdap Flyer (ID=166)

   Be Wise- Immunize! Activity Book (New February 2010) (ID=238)

   Certificate of Immunizations (pdf) (ID=68)

   Emergency Vaccine Relocation Plan Template (ID=255)

   FQHC Letter (pdf) (ID=70)

   FQHC Letter of Agreement (pdf) (ID=71)

   Guidance on the use of Pentacel® and Pediarix® (pdf) (ID=156)

   H1N1 Influenza Vaccination Record- Scanning Document (ID=212)

   How to Borrow and Return Vaccine in the NDIIS (ID=151)

   How to Correct Vaccine Inventory in the NDIIS (pdf) (ID=99)

   How to Enter Privately Purchased Vaccine into Providers Inventory in the NDIIS (pdf) (ID=119)

   How to Transfer Vaccine in the NDIIS (ID=100)

   How to Waste Vaccine in the NDIIS (ID=101)

   North Dakota Vaccine Loss Policy (pdf) (ID=73)

   Reporting H1N1 Vaccine to the NDIIS (powerpoint presentation) (ID=213)

   Temperature Log Immunization Cel (pdf) (ID=81)

   Temperature Log Immunization Far (pdf) (ID=82)

   Temperature Log Immunization Far Cel (pdf) (ID=83)

   Vaccine Administration Monthly Report For All Providers (pdf) (ID=74)

   Vaccine Administration Record (pdf) (ID=75)

   Vaccine Coverage Table (pdf) (ID=76)

   Vaccine Order Form (pdf) (ID=77)

   Vaccine Return Form (pdf) (ID=78)

   Vaccine Safety Fact Sheet (ID=168)

   Vaccine Transfer Form (pdf) (ID=79)

   Vaccines For Children (VFC) Questions and Answers (pdf) (ID=113)

   VAERS Reporting Forms (ID=104)

   Varicella Vaccination Algorithm (pdf) (ID=80)

   VFC Patient Screening Record (ID=254)