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How to Become a California Yellow Fever Vaccine Provider

Yellow Fever Alerts

  • Transfusion-Related Transmission of Yellow Fever Vaccine Virus
    The American Red Cross recommends that recipients of YF vaccine defer blood product donation for 2 weeks because of the theoretical risk for transmission from a viremic donor.
  • If you have any questions, please contact CDPH Immunization Branch at (510) 620-3737.

What is a Certified Uniform Stamp Holder?

The certified uniform stamp holder has the authority granted by the State of California to administer yellow fever vaccine to the public.  The stamp is used for international verification that a traveler has been vaccinated against yellow fever. The stamp is the property of the State of California, Department of Public Health, and is subject to recall at the discretion of the Department.  Uniform stamp certification is required to order and administer yellow fever vaccine.  Sanofi Pasteur will only ship yellow fever vaccine to a designated center associated with an active uniform stamp holder.

Who Can Apply

Applicants must be a physician (medical doctor or doctor of osteopathic medicine) with a current California medical license.

Steps to Becoming a Certified Uniform Stamp Holder:

  1. Submit the Certification Application ChecklistNew Window along with the following documents via email Yellow.Fever@cdph.ca.gov or fax to (916) 440-5962
  2. Uniform Stamp application (IMM-912)New Window
  3. Designation Form (IMM-903)New Window to ADD additional sites/providers
  4. Submit proof of completion the CDC Online Yellow Fever Course (Physician of Records as well as all designated medical staff.)
    http://www.cdc.gov/travel/training/
  5. ACIP Recommendations & Vaccine Storage Acknowledgement Form (IMM-914)New Window
  6. Proof of purchase of the International Certificate of Vaccination or Prophylaxis (ICV) card or a copy of the of the card will suffice.
    The ICV card is available for purchase from the Government Printing Office bookstore.  To order, visit http://bookstore.gpo.gov/search/apachesolr_search/yellow%20card. Packages of 25 are available for $24, and packages of 100 are available for $51.

Recertification 

Current stamp holders, please complete and submit the Recertification FormNew Window.  Once you are recertified, a new stamp will be issued and is valid for three years.  Please note - Sanofi Pasteur will not ship vaccine after the expiration date of your stamp.

Designating Yellow Fever Vaccine Centers

A designated yellow fever vaccine center is the place where your yellow fever vaccine will be shipped and administered. A yellow fever vaccine center must be under the jurisdiction of a stamp holder.  To designate vaccinating centers the uniform stamp holder must fill out and sign the Designation of a Yellow Fever Vaccine Center FormNew Window. You may order additional stamps for your sites if needed. Each stamp cost $36.00.

Lost or Damaged Stamp

You may request a replacement stamp by submitting the Uniform Stamp: Request for Replacement FormNew Window. If your stamp was damaged, please return it along with your request. Your stamp may be replaced only twice after the original or recertification issuing date (fee applies).

Vaccine Shipping Address Changes

Please submit the Change of Address FormNew Window after an address change has occurred at any of your designated sites.  Failure to submit this documentation will inhibit your ability to order vaccine.  This form must be signed by the uniform stamp holder in order to be processed.  The information will be updated accordingly on the Centers for Disease Control and Prevention (CDC) website, and with Sanofi Pasteur.

Yellow Fever Vaccination and Temperature Log

As a certified uniform stamp holder, you are required to maintain an updated vaccine temperature log and the Yellow Fever Vaccination LogNew Window.  You may use the VFC Temperature LogNew Window to record yellow fever vaccine temperatures. Please record this information twice a day. You are subject to an audit without notice, and will be asked to provide these logs for review.  Failure to provide this documentation upon request may result in the cancellation of your stamp and ability to order vaccine.

Questions?

Contact the Immunization Branch at 510-620-3737.

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Last modified on: 7/26/2013 9:06 AM