New Jersey Vaccines for Children (NJVFC) Program

Form Template

New Jersey Vaccines for Children (NJVFC) Program app is an enrollment form for health care providers providing free vaccines as part of an immunization program for adults.

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The applicant will indicate provider location type which may include health clinics and local health departments and indicate if providing Medicaid services. The provider should list each vaccination offered. Recommended vaccines include flu vaccine, TDAP vaccine, tetanus, measles, and human papillomavirus vaccines. The app is used to collect data about the provider population, as well. The provider will list the number of adults who received the vaccine by age for each vaccine eligibility categories of no health insurance or limited insurance in the last year. Using the app, the medical director will document all licensed medical providers in the office and acknowledge accountability for their compliance with the provider agreement.

Features
  • Signature Capture
  • Conditional Fields
  • Submission Editing
  • Reference Data
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Platforms
  • iPhone
  • iPad
  • Android
  • Windows
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Integrations
  • Quickbooks
  • Salesforce
  • Google Docs
  • Dropbox
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