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Colorado Vaccines for Children (VFC) Program Materials Request Form
The VFC Program provides listed items free of charge.
VFC Program forms are available to download and print at
www.coloradovfc.com
VFC Program Contact Information: 303-692-2650 or cdphe_VFC@state.co.us.
Order Date
*
+
VFC PIN
*
Contact Name
*
Contact Phone number
*
Contact's Email Address
*
Clinic Name
*
Clinic Mailing address
*
City
*
Zip Code
*
VFC Tags
Number of Refrigerator/Freezer Tags "Do Not Unplug"
English/Spanish, Heavy card to attach above wall plug.
Number of Breaker Box Warning Stickers
Pink stickers to affix to breaker box, 4"x2"
Number of Backup Battery "Do Not Unplug" Warning Tags
Orange tags to affix to backup battery power source, comes with ziptie
Note:
These are intended only for backup battery sources, not as a replacement for the original "Do Not Unplug" tags.
VFC and 317 Vaccine Box Stickers
Number of VFC Sticker Rolls (300 stickers per roll, limit 3 per order)
Orange "dot" stickers, 1" Diameter, to be used to label VFC vaccines
Number of 317 Sticker Sheets (250 stickers per roll)
Green "dot" stickers, 3/4" Diameter, to be used to label 317 vaccines
*Only for LPHAs, FQHCs, RHCs, and IHS
Data Logger and Supplies
Number of VFC400 Data Logger(s)
Acrylic Glycol Bottle Stands for VFC400 Data Loggers
VFC Providers may order (2) stands per clinic. If you order more than (2) stands, the order will be adjusted.
** DO NOT PLACE GLYCOL BOTTLE STANDS DIRECTLY INTO STORAGE UNIT AFTER RECEIPT. PRE-CHILL GLYCOL BOTTLE STANDS IN A UNIT THAT DOES NOT HOLD VACCINE.
Number of Wall Mount Brackets for VFC400 Data Loggers
VFC Providers may order (2) wall mount brackets per clinic to attach data loggers to refrigerators and freezers.
Number of LogTag USB Docking Station
Limit of (2) docking station per clinic
Clinical Supplies
Number of Anatomic Sites for Immunization Charts
8.5"x11" heavy stock chart for posting in immunization areas or exam rooms
Vaccine Storage Magnets and Static Clings
Number of REFRIGERATOR Vaccine Storage Guideline Magnets
*Please be aware whether you are ordering magnets or static clings.
Number of REFRIGERATOR Vaccine Storage Guideline Static Clings
Static clings will work with glass, stainless steel, wood, painted walls, mirros, cloth, monitors, and aluminum.
*Please be aware whether you are ordering magnets or static clings.
Number of FREEZER Vaccine Storage Guideline Magnets
*Please be aware whether you are ordering magnets or static clings.
Number of FREEZER Vaccine Storage Guideline Static Clings
Static clings will work with glass, stainless steel, wood, painted walls, mirros, cloth, monitors, and aluminum.
*Please be aware whether you are ordering magnets or static clings.