State Reports (All Except Alberta)

To run state reports, authorized users can click the Reports > State Reports link. The State Reports page opens.

Available reports depend on the state, as well as on the user's access level and permissions. Some reports can be scheduled to run during system off-peak hours. See Schedule a Report for more information.

Some of the available reports are as follows:

Texas:

• There are currently no state report for Texas

Alaska:

• VFC Provider Profile Report

• Vaccine Administered and VFC Eligibility Report

• Vaccine Shipping Invoice

• Alaska Aggregate Wastage Report

Arizona:

• Patient Record

• VFC Provider Profile

• Childcare Immunization Report

Indiana:

• Page 1 (pdf)

• Page 2 (pdf)

• Doses Administered Report

• Daily Patient Immunization List

• Immunization Signature Form

• Shot Record Card

• County Status Monthly Report

• Patient Association List

• Monthly Status by Race

• Monthly Status by Race and Facility

Louisiana:

• 402P Form, 402P Form (Blank)

• Health Information Requests

• Encounter Form

• Health Insurance Claim Form

• KIDMED

• Universal Certificate of Immunizations

• Universal Certificate for Higher Learning

• VFC VAR, VFC VAR Complete, VFC VAR Blank

• Vaccine Transfer Report

• Vaccine Administered

• High Risk Hepatitis B

• Forecast (Universal Certificate of Immunization Forecast Settings)

Mississippi:

• Certificate of Immunization Compliance (Blank)

• Certificate of Immunization Compliance

• Vaccine Administered

• Vaccine Expenditures

• Demographic Registry Report

• Immunization History Registry Report

• VFC Active Provider Profile

New Hampshire:

• Vaccine Administered and VFC Eligibility Report

Ohio:

• OH Immunization Record

Tennessee:

• IMMCert (Tennessee Immunization Certificate)

Washington:

• Immunization Detail Record Report

• Immunization Record Consent

• Patient Immunization Forecast

• Certificate of Immunization Status (CIS)

• Vaccination Screening Questionnaire

• PPD Report

• VFC Patient Breakdown

• Washington State Vaccine Administered Report

• Lot Number Summary Report

• Washington State Vaccine Monthly Doses Administered Report

• Washington State Vaccine Administered Submission Report

West Virginia:

When printing PDF reports, verify that the print settings do not have a checkmark next to Shrink oversized pages to paper size.

• Certificate of Immunization

• Certificate of Immunization (Blank)

• Provisional Certificate of Immunization

• Provisional Certificate of Immunization (Blank)

• Vaccine Need

• VFC Vaccine Order Form

• VFC Vaccine Order Form (Blank)

• Provider Activity (Summary)

• Provider Activity (Detail)

• Publicly Supplied Vaccines Nearing Expiration

• Exemption Aggregate Report

• Exemption Detail Report

• Oral Health Service Report

Wyoming:

• WyVIP Eligibility Log

• WyVIP Vaccine Lots to Expire Report - see Vaccine Lots to Expire Report

• Medical Record Report

• Patient Routing Slip

• School Form

• Benchmarking Report

• Batch HCFA 1500 Report

• WyVIP Inventory Summary Report

• High Risk for Adults Report