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Immunization Resources for Clinicians

Some resources are available for direct shipment. If you’d like to order free copies, please fill out this order form. The order form is operable in all internet browsers.

Clinical

• A Hallmark Greeting Card for New Parents only available for North Carolina birthing hospitals.(PDF, 2.15 MB)
• Lifetime Immunization Card (DHHS 1065) (PDF, 570 KB) (Updated February 2020)
• Adult Vaccination Record (DHHS 4040) (PDF, 81 KB)
• Vaccine Administered Log (VAL 122) (PDF, 398 KB) (Updated September 2024)
• Vaccine Administration Record (PDF, 656 KB) (Updated October 2022)
• Adult Vaccine Administration Record (DHHS 4057) (PDF, 1016 KB)
• NCIR Chart Stickers (PDF, 783 KB)
• Check Your Vials - Tdap or Dtap (PDF 1.24 MB)
• What Can You Do to Protect from the Flu? (PDF 1.52 MB) (English and Spanish) (Updated October 2018)

Vaccine Ordering, Storage and Handling

• Vaccine Inventory/Requisition Form (Updated December 2022)
• Vaccine Storage and Handling Kit
• NCIP Vaccine Storage and Handling
• To order VFC vaccines when NCIR is offline, please complete the Vaccine Order Form

State and Federal Rules and Laws

• Vaccine Injury Compensation
• NC Immunization Laws
• Medical Exemption Statement and Physician's Request for Medical Exemption Forms