How Do I Enroll?
Provider Enrollment and Agreement to Participate
Enrollment in the Nevada State Immunization Program's (NSIP) Vaccines for Children (VFC) Program is a simple process. To enroll, the provider must complete Agreement to Participate:
- Agreement to Participate - This form is the first step to becoming a VFC provider, and gives NSIP the information on all individuals within a practice who have prescription privileges related to child immunizations. Please read the form carefully and fill out completely. Incomplete forms will not be processed for enrollment.
By federal requirement, these forms must be completed on a yearly basis, even if there are no anticipated changes in the provider’s program. If, however, there are changes in a provider’s practice regarding persons with prescription writing authority, or in the partnership or legal make-up of the practice or office hours, the provider should contact the NSIP, to notify them of these changes.
Note: The Nevada State Immunization Program will notify each provider regarding yearly updating of the Agreement to Participate.
Submitting Your Agreement to Participate
Once the forms listed above are completed and signed by the provider (or authorized designee),email, fax, or mail forms to:
Nevada State Immunization Program
The provider should make copies of the completed forms and retain them for their files. Once the NSIP receives the Agreement, a State representative will contact each provider. The State representative will verbally outline several follow-up items that will be required before a provider is officially enrolled. Upon receipt of your completed forms, the State representative will issue your office an account number (Personal Identification Number- PIN). Please refer to this number for all contacts and transactions with the VFC program office.
Part of the enrollment process includes recording temperatures for the refrigerator and freezer where the vaccines will be stored. The NSIP’s temperature log form should be used and is available for download on this page. This log lists the correct temperature ranges for the safe storage of vaccines. You will be asked to submit a completed temperature log to the Nevada State Immunization Program once monthly and with each new vaccine request.
Once the NSIP has received all enrollment information, a State representative will schedule an enrollment visit. The enrollment visit will include a review of VFC program requirements, vaccine storage and handling procedures and allows you or your staff to have your questions answered. A Provider Manual will also be given that has important policies and procedures regarding VFC-supplied vaccine. Upon completion of the enrollment visit, and approval of vaccine storage unit, the NSIP will ship a starter kit of vaccines to your office.
2016 Influenza Vaccine Information