• 2013 Vaccine Distribution Enrollment: The Provider Agreement Form must be submitted online through VacTrAK. To view detailed instructions on how to access and submit the online Provider Agreement Form, see the Alaska Vaccine Distribution Provider Agreement Instructions (2013).
• Alaska Vaccine Distribution Handbook (February 2013)

VFC Forms

• VFC Vaccine Borrowing Form (CDC)
• "Do Not Unplug" Signs

Vaccine Distribution Program Forms

• 2012-2013 Influenza Vaccine Request Form
• Patient Eligibility Screening Record
• Vaccine Return & Facility Incident Report Forms
• Emergency / Power Outage Plan for Vaccines
• Emergency / Power Outage Plan for Vaccines (editable)
• Vaccine Temperature Log
• Vaccine Transfer Form
• Vaccine Adverse Event Reporting Form (VAERS)

Vaccine Information Statements

• Multiple Vaccine - This 4-page VIS may be used as an optional substitute for any or all of the routine birth-6 month vaccine VISs: DTaP, IPV, Hib, PCV, Hepatitis B, and Rotavirus.