Forms and Resources

Program Forms, Resources, and Documents

This page contains our entire library of forms, resources, documents, and guides. Each is organized by their related program or function for your convenience. You can also find these resources at the bottom of their respective pages throughout our website.

Please use the quick-links below to help find your resource faster. Having trouble locating a resource? Email us at vaccines@phila.gov for help!

PhilaVax | VFC/VFAAR |Community Outreach | Perinatal Hep B | COVID-19 | RSV | Homebound Vaccine Provider Toolkit | Mpox | Flu |Storage and Handling | Inventory & Ordering | Order Materials | Find a Clinic!

PhilaVax

Account Management Forms & Documents

Clinic Address and Delivery Hours Update Guide
Entity Confidentiality Form
Clinic Enrollment Form
How to Determine Correct Funding Code
PhilaVax User Agreement
Primary Agreement Signature Guide

Trainings and Presentations

PhilaVax Wastage Tutorial

Reporting Forms

2022-2023 Flu Vaccine Reporting Form
Adult Vaccine Reporting Form
Flat File Reporting Guide
No Doses Administered Reporting Form
Pediatric Vaccine Reporting Form
PhilaVax Recall Report Guide

Patient Resources

Medical Provider Patient Record Request and Update Form (for use by medical providers only)
Commonly Administered Vaccines
Patient Update Request
Patient Opt Out Form
PhilaVax Immunization Record Request Form (English)
PhilaVax Immunization Record Request Form (Spanish)
PhilaVax Immunization Record Request Form (Mandarin)
PhilaVax Immunization Record Request Form (Vietnamese)
PhilaVax Immunization Record Request Form (Korean)
PhilaVax Immunization Record Request Form (Russian)
PhilaVax Immunization Record Request Form (French)
PhilaVax Immunization Record Request Form (French)

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VFC/VFAAR

Enrollment

VFC/VFAAR Enrollment Job Aid
Staff Changes Job Aid
Primary Agreement Signature Guide

VFC Site Visit Folder Resource

10 Tips For VFC
Vaccine Coordinator Guide
VFC Eligibility Guide
VFC Eligibility Screening Record

Other Resources

Avoiding Administration Errors: Scheduling Errors
PhilaVax Recall Report Guide
Online Ordering: Inventory Management Job Aid
VFC and COVID-19 Vaccination Program Comparison
COVID Vaccine Ordering Guide

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Community Outreach

Immunization Requirements for Providers

Board of Health Regulations Governing the Immunization and Treatment of Newborns, Children, and Adolescents
PA Department of Health School Immunization Requirement Resources
Recommended Child and Adolescent Immunization Schedule for Ages 18 years or Younger
School District of Philadelphia Office of Student Health Services

Immunization Requirements Resources for Parents

Recommended Vaccinations for Infants and Children (CDC)
Getting Vaccinated
Office of Student Health Services
School District of Philadelphia Immunization Requirement Resources

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Perinatal Hep B

Resources

Asian Liver Center – Stanford University
Hepatitis B General Information Fact Sheets (CDC)
Hepatitis B and Sexual Health
Hepatitis B Vaccination of Infants, Children, and Adolescents (CDC)
Information for Gay/Bisexual Men (CDC)
Protect Your Baby for Life (CDC)
When Someone Close To You Has Hepatitis B (CDC)

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COVID-19

COVID-19 Vaccine Commercialization

COVID-19 Commercialization FAQ
Bridge Program Overview
Guide to COVID-19 Vaccine Ordering
Guide to COVID-19 Reconciliation
Guide to COVID-19 Accepting Shipments
Guide to COVID-19 Rejected Orders
Deauthorized COVID-19 Vaccine Products

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Homebound Vaccine Provider Toolkit

Community Resources

Community Legal Services

Center City Office (1424 Chestnut Street, Philadelphia, PA 19102 | 215-981-3700)
North Philadelphia Office (1410 W. Erie Avenue, Philadelphia, PA 19140 | 215-227-2400)
Landlord Tenant Help Center (1339 Chestnut Street, 10th Floor, Philadelphia, PA 19103)

Philadelphia Legal Assistance (718 Arch Street, Suite 300N, Philadelphia, PA 19106 | 215-981-3800)
Partnership for Inclusive Disaster Strategies

Older Adults Resources

Center for Advocacy for the Rights and Interests of the Elderly (CARIE)
Philadelphia Corporation for Aging (PCA)
Senior Law Center

Intellectual/ Developmental Disability Resources

ASERT- Autism, Services, Education, Resources and Training Collaborative
The Arc of Philadelphia
Jefferson Center for Autism & Neurodiversity
Philadelphia Autism Project
Vision for Equality

Deaf/ Hard-of-Hearing/ Deaf-Blind

PA School for the Deaf
Tech Owl- Deaf Blind Services
Deaf Hearing Communication Centre

Blind/ Visually Impaired

Associated Services for the Blind and Visually Impaired
Tech Owl- Deaf Blind Services

General Resources

Liberty Resources
Mayor’s Office for People with Disabilities
Disability Rights PA

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RSV

Nirsevimab (Beyfortus) Townhall Resources

PDPH Presentation Slides – Outpatient
PDPH Presentation Slides – Inpatient
Nirsevimab FAQ
Nirsevimab Planning Checklist

Mpox

Enrollment

Mpox Vaccine Provider Interest Survey

Presentations and Trainings

Mpox Vaccination Distribution Presentation

Other Resources

JYNNEOS Vaccine Storage Letter
Vaccine Ordering Form
Mpox Vaccine Wastage Guide
EUA for JYNNEOS

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Flu & Community Flu Clinics

Flu Resources

Information on Influenza (American Lung Association)
National Foundation for Infectious Diseases (NFID)
Number of Doses of Flu Vaccine to Give to Children
Seasonal Flu Basics (CDC)
Seasonal Flu Updates (CDC)

Preparing for the Flu Season

CDC’s Make a Strong Recommendation Page and Toolkit
Flu Vaccine Hesitancy Conversation Flowchart
Foster Support for Vaccination in Your Office (CDC)
“I Get It!” Flu Campaign Materials
Make a Strong Flu Vaccine Recommendation
Preparing for Questions Parents May Ask about Vaccines

Ordering Flu Materials

Order flu posters and prints for your office today!

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Inventory & Ordering

Managing Inventory

Guide to Wastage

Temperature Data Reporting

Submitting Temperature Log Guide

Ordering

Online Ordering Training Video
Online Ordering Job Aid
VFAAR Available Vaccine List
VFC Available Vaccine List
Ordering Formula Job Aid
Guide to Check Order Status

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Order Materials

Immunization Materials Ordering Forms

Adult Immunization Materials Order Form
COVID-19 Vaccine Materials Ordering Form
Flu Immunization Materials Ordering Form
Pediatric Immunization Materials Ordering Form

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Find a Clinic!

Federally Qualified Health Centers (FQHCs) in Philadelphia

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