VVFA Forms

Free Clinics – Flu Only

The Association of Free Clinics works closely with the Division of Immunization to offer Influenza vaccine for uninsured and underinsured adults.  Free Clinics must use continuous temperature monitoring devices, (data loggers) to ensure vaccine viability.

Clinics Offering Influenza and other ACIP recommended vaccines for adults

(Free Clinics, FQHCs, RHCs, CHCs)

Vaccine Use Guidelines

Uninsured or Underinsured Adults (19 years of age and older)

Uninsured and underinsured adult clients should receive all ACIP recommended vaccines using DOI-supplied vaccine according to the current Recommended Adult Immunization Schedules http://www.cdc.gov/vaccines/schedules/hcp/adult.html

Underinsured is defined as: A person who has commercial (private) health insurance, but the coverage does not include vaccines; a person whose insurance covers only selected vaccines (eligible for non-covered vaccines only); or a person whose insurance caps vaccine coverage at a certain amount. Once that coverage amount is reached, the person is categorized as underinsured.


VFA Only

Bridge Program

This form is for Bridge Access Providers authorized to order COVID-19 vaccine only