Novel H1N1 Influenza Provider Profile and Agreement
for Vaccine Administration Sites in Virginia

The Virginia Department of Health (VDH) has pre-registered more than 2,900 facilities as possible vaccine administration sites for the 2009 novel H1N1 influenza vaccine.  This outstanding response is a testament to your commitment to protecting public health and your patients. 

The next step toward receiving the H1N1 vaccine is to complete a Provider Profile and an H1N1 Vaccine Provider Agreement that includes stipulations on vaccine use and accountability as defined by federal and state authorities.  Please read the information below and instructions on how to register, and click the link at the bottom to complete the registration process.  

 

 

Why the Provider Agreement and Profile

The Provider Agreement is required for each site or system that will administer the H1N1 vaccine.  Please ensure all participating sites and/or practitioners have read and will comply with the terms of the agreement. In the Provider Profile, provide accurate information on delivery address and business hours, as well as your patient profile. Sites will be asked to submit an H1N1 vaccine order request after completion of the Provider Agreement and Profile. When H1N1 vaccine does become available for shipping (likely in October), VDH makes no guarantee that sites will be shipped vaccine in the requested amounts and formulations.  We will do our best to accommodate all vaccine orders. 

 

Considerations

Recording doses: Sites that wish to administer H1N1 vaccine are expected to enroll and participate in VIIS (Virginia Immunization Information System).  For information on enrolling in VIIS, see http://www.vdh.virginia.gov/epidemiology/immunization/viis/index.htm

Only for those sites without internet access, VDH will provide an alternative paper-based process for reporting doses administered.  This form is forthcoming, and will be posted on this website. 

Financing and insurance issues: Sites CANNOT charge for the vaccine, syringes or the needles as these will be provided at no cost.  Charges for the administration fees are specified in the Provider Agreement (see also the Registration FAQ below). 

Resources for Vaccination Sites

• Registration Frequently Asked Questions (FAQ)
• H1N1 Vaccine Information from CDC
• H1N1 Vaccine Storage and Handling Information
• Vaccine Storage and Handling Checklist
• Vaccine Information Statement
  • Inactivated
  • LAIV

Instructions –Please print a copy of the instructions below for use in completing registration.

• Instructions for pre-registered providers
• Instructions for providers who have not already pre-registered
• Formulations and Age Indications
  

Provider Profile and Provider Agreement for H1N1 Vaccine Administration Sites

For Questions Contact:
Phone: 804-864-8055
Email: H1N1vaccine@vdh.virginia.gov
Check this website often for updates.

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