Wyoming Immunization Section - Vaccine Program

Lisa Wordeman

Vaccine Program Specialist 

307-777-2413

 

LaChel May

Provider Relations Administrative Assistant     

307-777-8503

 

Fax reports to:  307-777-3615

 

WyVIP Providers in Wyoming by County (clickable map) 

2010 WyVIP Policy and Enrollment Packets

Agreements must be submitted, with original signatures by mail 

No Later Than February 19, 2010

2010 WyVIP/VFC Policy Packet

2010 Non-PHN Child Agreement

2010 Non-PHN Adult Agreement  

2010 PHN Child Agreement 

2010 PHN Adult Agreement  

 

WyVIP Provider Forms

Vaccines Currently Available through WyVIP (VAC1)  updated 02/02/10

Doses Administered Form (VAC2)  updated 02/02/10

Vaccine Request Form    updated 02/02/10

Special Clinic Order Form (VAC3)  updated 02/02/10

Special Clinic Doses Administered Form (VAC4)  updated 02/02/10

Flu Doses Administered and Inventory Form (VAC5) updated 02/02/10

Expired and Wasted Vaccine Return Form (VAC6)  updated 02/02/10

Vaccine Transfer Form (VAC7)  updated 02/02/10

Vaccine Temperature Log - Celcius (VAC9)  updated 02/02/10

Vaccine Storage Troubleshooting Report    updated 02/02/10

Current Inventory Form (VAC10)  updated 02/02/10

Flu Special Clinic Order Form (VAC11)  updated 02/02/10

Vaccine Transfer Request (VAC12)  updated 02/02/10

Vaccine Arrival Report (VAC13)

Emergency Plan Form for Providers  Clickable PDF Updated September 4, 2009    

Emergency Plan Example       Updated September 4, 2009 

         

OTHER INFORMATION

Sharp Shooter Award Application 

Handle With Care-Cold Chain Flyer   Updated October 6, 2009

 

Cold Chain and Vaccine Storage and Handling Information