Farmworker Supplemental Flu Request Form

North Carolina Local Health Departments wanting to participate in the 2024-2025 Supplemental Farmworker Flu program should request vaccine using this form. The doses for farmworkers should be kept separate from 317 VFA and VFC vaccines as they can only be administered to eligible patients.


If you have any questions or need support, please contact the NC Vaccine Help Desk at ncirhelp@dhhs.nc.gov or by calling (877) 873-6247 and select option 1.

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By ordering these doses, I am agreeing to the following.

Eligibility

  • State-supplied seasonal flu vaccine must be administered at no cost to eligible recipients, (any farm-based employee, 19 years of age or older, who works with live animals such as poultry, cattle, hogs, etc.), regardless of insurance status. Doses are not to be used for workers in meat processing facilities.
  • To help extend the supply of farmworker flu vaccine, private vaccine should be used for fully insured individuals when possible.
  • VFC vaccines should be used only for VFC-eligible individuals under 19 years of age.
  • Screen individuals for program eligibility using a standardized question, such as: “Do you work with dairy cows or calves, poultry, or some other animal on a farm?” If the answer is “yes” and doses are administered as part of this campaign, administrations must be documented in NCIR within 24 hours of administration.

Documentation Requirements

Participating LHDs are required to document farmworker occupation for each dose administered as part of this program. A new client comment field was added to NCIR to denote the farmworker occupation. Instructions for how to add the new client comment can be found here.

Reporting Requirements for Local Health Departments Receiving AA720 Funding:

(Participating Counties Include: Alexander, Anson, Bladen, Chatham, Duplin, Greene, Harnett, Iredell, Johnston, Moore, Randolph, Robeson, Sampson, Surry, Wayne)


Monthly reports to include each month's number of mobile vaccination clinics conducted and for the State-supplied seasonal influenza vaccine provided . This reporting includes each months number of eligible farmworkers vaccinated and each month's number of wasted or spoiled vaccine doses. Monthly reporting can be submitted here.

Requested Doses

Please enter the number of doses under each product you are requesting.


Minimum order quantity 10

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Minimum order quantity 10

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Minimum order quantity 10

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Is there any additional information you'd like to share with the North Carolina Immunization Program regarding your vaccine request?