Transcript New VFC Order Form: Why do I have to do this?

New VFC Order Form:
Why do I have to do this?
How do I fill it out?
By Laura Harrod,
KVP Coordinator
Why do we have to do this form?
 Part of CDC’s Vaccine Management Business
Improvement Plan or VMBIP
 CDC is requiring more accountability of vaccines
 New system called VTrckS or Vaccine Tracking System
requires all information on this form to be able to
order any vaccines
 This information will need to be input for VFC as well
as adult vaccines (Leslee Minch will send the Adult
form sometime before January)
How do I fill it out?
 Current form was sent out in PDF
 Fill out by hand then fax or scan & email it to the
program
 Working on getting in a fillable PDF form so you can
fill in electronically and send
Identification Information
 Date, the actual date you are filling in form
 Correct VFC PIN that starts with H
 Prepared by…this is actual person filling in form. It
may not be VFC contact
 Provider Name: actual name of your clinic, if there is
more than one in your county you might need to add
city: Bell Co HD-Middlesboro & Bell Co HD-Pineville;
initials do not help ex. BCHC
 Check if new address; you should have already
discussed with us before submitting
Identification Information continued:
 NEW FOR THIS FORM:
 Put in office hours (If you want to leave off Friday that is
ok since we do not deliver on Friday’s unless it is an
emergency.)
 Dates closed in next 30 days
VACCINES
DAPTACEL
10 VIALS
(SANOFI)
INFANRIX
10
DTAP
SYRINGES
(GSK)
INFANRIX
10 VIALS
(GSK)
TRANSFER/
REQUEST PREVIOUS ORDERS
DOSES CURRENT NDC LOT EXPIRATION
EXPIRED
DOSES
STOCK RECEIVED
GIVEN STOCK
#
#
DATE
DOSES
Order Form
 Left column is actual vaccine.
 Ex is “DTAP.” This form uses all CAPS rather than DTaP.
These are the only brands & presentation we carry
 If you do not want us to substitute brand you must write
it in on your form somewhere near vaccine, we will do
our best but as always cannot guarantee brand
 DO NOT start on left columns but in the “current
stock” column. Write down EXACT VFC doses you
have in your frig.
 If you have more than 2 lot numbers go to the back page
(example on next slide)
• This is page 4 of the order form – use page 4 to
record lot numbers if you have more than 2 lot #s
of any vaccine.
VACCINES
CURRENT
STOCK
NDC#
LOT#
EXPIRATION
DATE
NDC#
 After current stock fill in NDC or National Drug Code
 Usually on front of box
Lot # and expiration date
 Fill in for each lot you have of each specific vaccine
 One line per lot #
Doses Given
 To find out how many doses given you can pull a CDP
report but must make sure it is all VFC and not private
stock or use Activity Worksheet (see example in the
next slide)
KVP ACTIVITY WORKSHEET
<1 1-6 7-18
year yrs yrs
Varicella
Tdap
Td Adult
.
ROTA
Prevnar
PNEUMO
Pentacel
Pediarix
MPSV4
End Date
MMR
MMRV
MCV4
Kinrix
Influenza
HPV4
Hib
HEPB-Hib
HEP B PF
Start Date
HEP B Adult
HEP A
HEP A Adult
IPV
DTaP
For each child
please indicate
appropriate
eligibility
status.*
Provider Name
DT
KVP PIN #
Activity worksheet
 This form is available for your use and is to be completed by
hand (we are working on making it a fillable PDF form)
 Put on frig or freezer and check off each vaccine as you pull
vaccine dose out of unit
 Fill one out monthly
 Age of patient is to left, in that box put:
 M – Medicaid or one of MCO
 U – Uninsured or no insurance
 N – Underinsured
 K – KCHIP
 I – American Indian or
 A – Alaska Native
Activity Worksheet continue
 Put x or check on line with shot given
 Many will have more than one shot
 Doses given will be how many x’s or check marks are in
the column for that specific vaccine
 Be sure to include flu doses administered as we use
these data to determine how much to send the next
year
Transfer/Expired doses
 If you fill out a Return and Adjustment form you must
fill in that column
 It would be a good idea to send Return form at the
same time you send order
Orders received
 Since you sent in your last order, put in all VFC doses
received by your site
Previous Stock
 Get “previous stock” from your last order form where it
says “current stock”
 This will be the number of doses you had after you
submitted the previous order
 Do each vaccine the same way
 In a perfect world, which we are going towards…your
order form should add up.
PREVIOUS
STOCK
ORDERS
RECEIVED
TRANSFER
/ EXPIRED
DOSES
DOSES
GIVEN
CURRENT
STOCK
100
50
10
50
90
Eligibility
 On page 4 of 4.
 Use either a CDP report or the Activity Worksheet to
get number of patients.
 This will be much smaller than the number of doses
given since some patients can get 5 or 6 doses of
vaccine. You are reporting patients not doses.
 Eligibility category are the same as on the Activity
Worksheet
Questions?
 Contact Kentucky Vaccine Program
 502-564-4478 and put in our extension (do not press 1
for Immunization since that goes to LaKeta Ritchie)
 (these will all change in November)
 Rita Lathrem x3914 does HD orders
 Judy Baker x3518
 Laura Harrod x3855
 Clarissa Wilson x3734
 Email inbox is [email protected]
 Fax 502-696-4923