{"id":3726,"date":"2018-12-17T15:43:23","date_gmt":"2018-12-17T15:43:23","guid":{"rendered":"https:\/\/www.vdh.virginia.gov\/immunization\/?page_id=3726"},"modified":"2025-11-24T11:13:36","modified_gmt":"2025-11-24T16:13:36","slug":"vvfaforms","status":"publish","type":"page","link":"https:\/\/www.vdh.virginia.gov\/immunization\/vvfa\/vvfaforms\/","title":{"rendered":"VVFA Forms"},"content":{"rendered":"<div id=\"pl-3726\"  class=\"panel-layout\" ><div id=\"pg-3726-0\"  class=\"panel-grid panel-has-style\" ><div class=\"mt-3 panel-row-style panel-row-style-for-3726-0\" ><div id=\"pgc-3726-0-0\"  class=\"panel-grid-cell\" ><div id=\"panel-3726-0-0-0\" class=\"so-panel widget widget_sow-editor panel-first-child panel-last-child\" data-index=\"0\" ><div class=\"panel-widget-style panel-widget-style-for-3726-0-0-0\" ><div\n\t\t\t\n\t\t\tclass=\"so-widget-sow-editor so-widget-sow-editor-base\"\n\t\t\t\n\t\t>\n<div class=\"siteorigin-widget-tinymce textwidget\">\n\t<h3>Free Clinics \u2013 Flu Only<\/h3>\n<p>The Association of Free Clinics works closely with the Division of Immunization to offer Influenza vaccine for uninsured and underinsured adults.\u00a0 Free Clinics must use continuous temperature monitoring devices, (data loggers) to ensure vaccine viability.<\/p>\n\n<h5>Clinics Offering Influenza and other ACIP recommended vaccines for adults<\/h5>\n<p>(Free Clinics, FQHCs, RHCs, CHCs)<\/p><\/div>\n<\/div><\/div><\/div><\/div><\/div><\/div><div id=\"pg-3726-1\"  class=\"panel-grid panel-no-style\" ><div id=\"pgc-3726-1-0\"  class=\"panel-grid-cell\" ><div id=\"panel-3726-1-0-0\" class=\"so-panel widget widget_sow-editor panel-first-child panel-last-child\" data-index=\"1\" ><div class=\"panel-widget-style panel-widget-style-for-3726-1-0-0\" ><div\n\t\t\t\n\t\t\tclass=\"so-widget-sow-editor so-widget-sow-editor-base\"\n\t\t\t\n\t\t>\n<div class=\"siteorigin-widget-tinymce textwidget\">\n\t<h3>Vaccine Use Guidelines<\/h3>\n<p>Uninsured or Underinsured Adults (19 years of age and older)<\/p>\n<p>Uninsured and underinsured adult clients should receive all ACIP recommended vaccines using DOI-supplied vaccine according to the current Recommended Adult Immunization Schedules: <span style=\"text-decoration: underline\"><a href=\"https:\/\/www.cdc.gov\/vaccines\/hcp\/imz-schedules\/adult-age.html\">https:\/\/www.cdc.gov\/vaccines\/hcp\/imz-schedules\/adult-age.html<\/a><\/span><\/p>\n<blockquote class=\"mx-3\" style=\"background: #fff\">\n<p>Underinsured is defined as: A person who has commercial (private) health insurance, but the coverage does not include vaccines; a person whose insurance covers only selected vaccines (eligible for non-covered vaccines only); or a person whose insurance caps vaccine coverage at a certain amount. Once that coverage amount is reached, the person is categorized as underinsured.<\/p>\n<\/blockquote>\n<\/div>\n<\/div><\/div><\/div><\/div><\/div><div id=\"pg-3726-2\"  class=\"panel-grid panel-no-style\" ><div id=\"pgc-3726-2-0\"  class=\"panel-grid-cell\" ><div id=\"panel-3726-2-0-0\" class=\"so-panel widget widget_sow-editor panel-first-child panel-last-child\" data-index=\"2\" ><div class=\"panel-widget-style panel-widget-style-for-3726-2-0-0\" ><div\n\t\t\t\n\t\t\tclass=\"so-widget-sow-editor so-widget-sow-editor-base\"\n\t\t\t\n\t\t><h3 class=\"widget-title\">Forms<\/h3>\n<div class=\"siteorigin-widget-tinymce textwidget\">\n\t<p><strong>VFA Only<\/strong><\/p>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li><a href=\"https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/11\/2021\/03\/AdultOrderForm20240621.pdf\">Adult Order Form<\/a><\/li>\n<li><a href=\"https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/11\/2021\/03\/FluOrderForm.pdf\">Flu Order Form<\/a><\/li>\n<li><a href=\"https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/11\/2022\/12\/VFAEligibilityDoc.pdf\">Determining Vaccines for Adults (VFA) Eligibility<\/a><\/li>\n<li><a href=\"https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/11\/2019\/09\/Adult_Eligibility.pdf\">Adult Eligibility Screening Record<\/a><\/li>\n<li><a href=\"https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/11\/2016\/04\/return_form.pdf\">Return\/Transfer Form<\/a>\u00a0(Right click and choose save link as\u2026 to use the Adobe Fillable form feature.)<\/li>\n<li><a href=\"https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/11\/2019\/01\/FMQ-Replacement-Program-Overview-final-12.4.18-002.docx\">FluMist Quadrivalent Replacement Program<\/a><\/li>\n<li><a href=\"https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/11\/VVFA-Routine-Vaccine-Management-Plan.docx\">VVFA Routine Vaccine Management Plan<\/a><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/div>\n<\/div><\/div><\/div><\/div><\/div><\/div>","protected":false},"excerpt":{"rendered":"<p>Free Clinics \u2013 Flu Only The Association of Free Clinics works closely with the Division of Immunization to offer Influenza vaccine for uninsured and underinsured adults.\u00a0 Free Clinics must use continuous temperature monitoring devices, (data loggers) to ensure vaccine viability. Clinics Offering Influenza and other ACIP recommended vaccines for adults (Free Clinics, FQHCs, RHCs, CHCs)<\/p>\n","protected":false},"author":385,"featured_media":0,"parent":956,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_lmt_disableupdate":"no","_lmt_disable":"","inline_featured_image":false,"footnotes":""},"tags":[],"class_list":["post-3726","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.3 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>VVFA Forms - Immunization<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.vdh.virginia.gov\/immunization\/vvfa\/vvfaforms\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"VVFA Forms - Immunization\" \/>\n<meta property=\"og:description\" content=\"Free Clinics \u2013 Flu Only The Association of Free Clinics works closely with the Division of Immunization to offer Influenza vaccine for uninsured and underinsured adults.\u00a0 Free Clinics must use continuous temperature monitoring devices, (data loggers) to ensure vaccine viability. 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