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TVFC Program Vaccine Transfer Authorization Form 2021
3 years to younger 7 years to younger 1 year of age than 3 years old than 7 years old than 19 years old Total Enrolled in Medicaid or Medicaid-eligible UNinsured American Indian / Alaska Native UNDERinsured FQHC/RHC or deputized PHC/LHD ONLY 1 Total FEDERAL VFC TVFC Eligibility Categories UNDERinsured private facilities or non-deputized PHC/LHD 1 Children s Health Insurance Program CHIP 2 Total TEXAS VFC TVFC Insured Patients INSURED health insurance covers vaccines for vaccines that are not...
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