Program Requirements 

• LHD 317 Provider Agreement (PDF) 
• CA LHD 317 Provider Agreement Addendum (PDF) 
• Participation Withdrawal Request Form (PDF)

Eligibility Screening & Documentation 

Guidelines 

• Vaccine and Clinic Eligibility Guidelines by Funding Source (PDF) 
• 317 Eligibility Based on Insurance Status (PDF) 

How to Screen 

• 317 Eligibility Screening & Documentation Requirements 
• 317 Eligibility Screening Record for Adult Patients (PDF) | Screening Record in Spanish (PDF) 

Vaccine Guidance 

See resources for all providers. 

• Schedules & Recs  
• Clinic Resources (see product guides, fact sheets, VISs, standing orders & more) 
• Health Education by Vaccine & Population

Vaccine Management 

• Storage & Handling Resources 
• Inventory Management Resources