It's a New Day in Public Health.
The Florida Department of Health works to protect, promote, and improve the health of all people in Florida through integrated state, county, and community efforts.
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Forms and Records
Contact the Immunization Section
- 1-877-888-7468
- Immunization@FLHealth.gov
-
Fax
850-922-4195 -
Mailing Address
Florida Department of Health
Immunization Section
4052 Bald Cypress Way, Bin A11
Tallahassee, FL 32399-1719
Patient Eligibility
- Patient Eligibility Screening Record
- Comprehensive Certification Form for American Indians and Alaskan Natives
- Comprehensive Certification Form for Children Enrolled in Medicaid
- Patient Eligibility Screening Record for Family Planning Clinics
- Unaccompanied Minor without Insurance Information VFC Log
Provider Enrollment Forms
- Initial Enrollment Forms
- Reenrollment Forms
- Disenrollment Form
- Maximum Regional Charges for Administration
- Suspected Fraud and Abuse Report Form
Reporting Forms
- List of Ordering Schedules by PIN
- Report Forms and Ordering Schedules
Providers will now report and order through the Florida SHOTS. - Report Form Additional Page
- Administration Redistribution Agreement
Other Order Forms
- Varicella-Containing Order Form
Providers will now order through the Florida SHOTS™ system.
Vaccine Management
- Temperature Log (Fahrenheit)
- Temperature Log (Celsius)
- Vaccine Usage Worksheet
- Vaccine Return and Waste Form
Providers will now report and order through the Florida SHOTS. - Vaccine Transfer Form
Providers will now report and order through the Florida SHOTS. - Cooler Temperature Log
- Vaccine Management Plan
- Using a Data Logger to Ensure Proper Vaccine Management
- Emergency Response Plan
Connect with DOH