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Alabama Vaccines for Children (VFC) Annual Provider Profile

Each VFC provider must complete this electronic VFC Annual Profile by July 1, 2019. The annual profile indicates each provider's agreement will comply with all the conditions of the federal VFC program, which includes annual VFC education requirement or a VFC compliance visit. VFC education can include training on-line, Webinar, or in-person presentation (submit request online at ADPH CE Webpage ).

Each profile must be electronically signed by the medical director or equivalent in a group practice. All other providers (MD, PA, and CRNP) in the practice must be listed in the designated section of this form. Please allow an adequate amount of time to complete this electronic form, we estimate you will need about 45 minutes. VFC staff will send an email acknowledging receipt of your profile submission. Please print the Emergency Response Plan (required to post on the outside of provider's refrigerator for all staff ), and optional Provider Profile Tool and Emergency Response Worksheet while completing the profile or go to ADPH VFC Webpage. If you have any questions, please call the Alabama VFC Program at 1-866-674-4807.

To begin completing the Annual Profile, please select SAVE & CONTINUE below.

Printable Form:
  • Provider Profile Tool