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Vaccines for Children (VFC) Program Patient Eligibility Screening

Vaccines for Children (VFC) Program Patient Eligibility Screening 2025

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The document outlines the Vaccines for Children (VFC) Program Patient Eligibility Screening Record Form, which is used to determine and document the eligibility of children aged 18 and under for publicly funded vaccines during immunization visits. It specifies that records must be maintained for at least three years and details the eligibility categories for VFC and state vaccine programs. The form must be completed by parents or healthcare providers at each visit to ensure compliance with eligibility requirements.

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Click ‘Get Form’ to open it in the editor.
Begin by filling in the Child’s Name and Date of Birth. Ensure you include the last name, first name, and middle initial for accurate identification.
Next, enter the Parent/Guardian/Individual of Record's details. This section requires their full name to establish responsibility for the child.
Input the Provider’s Name, ensuring all fields are completed accurately to maintain proper records.
For each immunization visit, record the date and assess eligibility by marking the appropriate column based on the child's insurance status. Columns A-D indicate eligibility for VFC vaccines, while E-G denote non-eligibility.
Review all entries for accuracy before saving your document. This ensures compliance with documentation requirements for VFC participation.

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Versions	Form popularity	Fillable & printable
2024	4.7 Satisfied (40 Votes)
2019	4.6 Satisfied (39 Votes)
2014	4 Satisfied (32 Votes)

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Where can underinsured VFC eligible children receive VFC vaccines Quizlet?

Underinsured children are only eligible to receive vaccines at Federally Qualified Health Centers (FQHCs) or Rural Health Clinics (RHCs). FQHCs and RHCs provide health care to medically underserved areas and meet certain criteria under Medicare and Medicaid programs.

When a VFC eligible patient is unable to pay the vaccine administration fee providers can deny administration?

If a VFC - eligible patient is unable to pay the vaccine administration fee, providers can deny administration of the next dose of VFC vaccine until the administration fee is paid.

What are the rules for VFC?

To receive VFC vaccine, a patient must be under the age of 19 and must be at least one of the following: (1) Medicaid eligible; (2) uninsured (i.e., child has no health insurance); (3) underinsured (i.e., child has health insurance, but does not have cover for any or certain vaccines underinsured children may only

Are underinsured children eligible to receive VFC vaccine only through a local health department in New Jersey?

Underinsured children are eligible to receive vaccines only at Federally Qualified Health Centers (FQHCs).

Which of the following children would be eligible for the vaccines for children VFC Program?

VFC vaccine can only be administered to children from birth through 18 years of age and who meet at least one of the following criteria: Medi-Cal Eligible, Uninsured, underinsured, American Indian Alaskan Native.

Where can underinsured patients receive VFC vaccines?

Underinsured (uninsured children can only receive free vaccines at Federally Qualified Health Centers (FQHCs) or Rural Health Clinics (RHCs))

What is the purpose of the vaccines for children VFC program?

The Vaccines for Children Program(VFC) was created to help raise childhood immunization levels, especially among infants and young children.

How to bill for VFC vaccines?

The administration fee for the VFC Measles, Mumps, Rubella and Varicella (MMRV) vaccine is billed with CPT code 90710 and modifier SL for children 12 months through 12 years of age (before the 13th birthday) who need a first or second dose of MMR and varicella vaccine.

Vaccines for Children (VFC) Program Patient Eligibility Screening 2025

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