To submit Reports to the Kansas Vaccines For Children Program:

Email Reports to: immreporting@kdheks.gov

Monthly Immunization Report Form:

• Monthly Immunization Report (MIR) (.doc)
• Monthly Immunization Report (MIR) (.xls)
• Monthly Tally Sheet for Vaccines (.doc)
• Hospital VFC Monthly Immunization Report (.doc)
• Hospital VFC Monthly Immunization Report (.xls)– Includes Tdap Vaccine

Temperature Log Forms:

• Celsius Temperature Log for Vaccines Days 1-15 (.doc)
• Celsius Temperature Log for Vaccines Days 1-15 (.xls)
• Celsius Temperature Log for Vaccines Days 16-31 (.doc)
• Celsius Temperature Log for Vaccines Days 16-31 (.xls)
• Fahrenheit Temperature Log for Vaccines Days 1-15 (.doc)
• Fahrenheit Temperature Log for Vaccines Days 1-15 (.xls)
• Fahrenheit Temperature Log for Vaccines Days 16-31 (.doc)
• Fahrenheit Temperature Log for Vaccines Days 16-31 (.xls)

Vaccine Wastage Forms:

• VFC Wasted Vaccine Return Procedure
• Wasted Vaccine Return Form (.pdf)
• Wasted Vaccine Return Form (.doc)

VFC Borrowing/Guidance Forms:

• Borrowing Guidance
• Borrowing Form (.pdf)
• VFC Vaccine Borrowing Report (.doc)

Fax Orders and Reports to: (785) 296-6510