Vaccine Inventory Form - Immunize Utah - health utah 2026

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering your VFC PIN and the date submitted at the top of the form. This information is crucial for tracking your vaccine inventory.
  3. Fill in your facility name and contact phone number, ensuring that all details are accurate for effective communication.
  4. For each vaccine type listed, create a new row for each lot number. Enter the manufacturer, lot number, NDC number, expiration date, and the number of doses available.
  5. After filling out each section, calculate the total number of doses for each vaccine type and enter this sum in the Grand Total column.
  6. Once completed, make a photocopy for your records. Submit the form with your vaccine order via FAX to (801) 538-9322 or mail it to the Utah VFC Program.

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All Utah local health departments use or are connected to Utah Statewide Immunization Information System (USIIS). Contact your local health department and ask them to print an Official USIIS Personal Utah Immunization Record for you.
The Vaccine App is an official digital vaccine card replacing all paper counterparts globally. Your personal vaccine record keeper, a digital record which you can never lose.
The Utah Statewide Immunization Information System (USIIS) is a free, confidential, web- based information system that maintains immunization histories for Utah residents. USIIS consolidates immunization records from multiple providers into a central location, reducing the need to rely on parents to obtain information.
Docket - Immunization Records on the App Store.