Forms and Guides for Vaccine Providers

Vaccines Administered Log (PDF)
This log can be used to meet state and federal requirements, provide patient information to local health departments or fulfill Vaccines for Children (VFC) requirements.

Vaccine Administration Record (PDF)
Information collected on this form will be used to document authorization for receipt of vaccines.

ACIP Vaccine Recommendations and Guidelines

Child and Adolescent Immunization Schedule

Catch-Up Immunization Schedule for Children and Adolescents

Adult Immunization Schedule

Adult Immunization Standards

Influenza (Flu) Updates

Vaccine Inventory/Requisition Form
To order VFC vaccines when NCIR is offline, complete the Vaccine Inventory Form.

CDC Vaccine Price List

Checklist: Supplies You May Need at an Immunization Clinic (PDF)

Check Your Vials - Tdap or Dtap (PDF)
This poster provides an overview of Tdap and Dtap vaccine brands by age group.

COVID-19 Vaccine Product Information
The CDC’s guide to vaccine information by brand, plus education for patients and parents.

“Do Not Unplug” Sign for Refrigerator/Freezer – English/Spanish (PDF)

For more resources, visit Vaccine Storage and Handling and the CDC's Vaccine Storage and Handling Kit (PDF).

Medical Exemption (DHHS 3987) (PDF)
Use this form for true contraindications that are recognized by the Commission for Public Health.

Physician’s Request for Medical Exemption (DHHS 3995) (PDF)
Use this form for contraindications not recognized by the Commission for Public Health.

For more resources, visit NC Rules and Laws on Immunizations and Vaccine Injury Compensation.

NCIR HEDIS Extract Job Aid (PDF)

Contraindications and Precautions for Vaccines

CDC Pink Book: Epidemiology and Prevention of Vaccine-Preventable Diseases

CDC Yellow Book for International Travelers

Vaccine-Preventable Disease Reporting

Immunization Action Coalition (IAC) Clinical Resources Library

Patients and parents can feel more confident about vaccinating when everyone in the practice — from the front desk to the exam room to checkout — shares the same message.

Foster Support for Vaccination in Your Practice
The CDC’s guide to techniques and processes to foster support for vaccines in your practice.

How to Support Vaccination in Your Practice (PDF)
An infographic poster to remind staff how they can support vaccination.

Strategies for Increasing Adult Vaccination Rates
The CDC’s guide to helping health care professionals improve adult vaccination rates and reduce the number of missed opportunities for vaccinations.

Sample Declination Form (PDF)

Association for Professionals in Infection Control and Epidemiology (APIC)
Provides guidelines and standards for infection prevention.