Immunization Resources for Providers
The NCIP no longer ships materials to providers due to funding issues. However, you can print any of the items on this page.
- COVID-19 Vaccine Product Guide (CDC) - Please note you cannot order materials from this site.
- Resources for Increasing Immunizations:
| Preview Image | Description of Materials & Download Links |
|---|---|
| Lifetime Immunization Card (DHHS 1065) - (Updated Feb. 2020)
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| Adult Vaccination Record (DHHS 4040) |
| Vaccine Administered Log |
| Vaccine Administration Record |
| Adult Vaccine Administration Record (DHHS 4057)
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| Check Your Vials - Tdap or Dtap |
| What Can You Do to Protect from the Flu? (English and Spanish) |
For more resources, visit our Vaccine Storage and Handling page and the CDC's Vaccine Storage and Handling Kit (PDF).
| Preview Image | Description of Materials & Download Links |
|---|---|
| Vaccine Inventory/Requisition Form (Updated Dec. 2022) To order VFC vaccines when NCIR is offline, complete the Vaccine Inventory Form |
| Do Not Unplug Sign for Refrigerator/Freezer |
For more resources, visit NC Rules and Laws on Immunizations and Vaccine Injury Compensation.
| Preview Image | Description of Materials & Download Links |
|---|---|
| Use this form for true contraindications, i.e. those recognized by the Commission for Public Health. |
| Physician’s Request for Medical Exemption Use this form for contraindications not recognized by the Commission for Public Health. |
This page was last modified on 04/09/2025