New Hampshire Immunization Program Vaccine Provider Profile Validation Initiative Sandra Kelsey, BS Vaccine Quality Specialist NH Immunization Program

New Hampshire Department of Health & Human Services

Validation Initiative: Why ? Validate number of patients, by category as they appear on Provider Profile. Impact: Vaccine Forecasting Vaccine Funding Streams

New Hampshire Department of Health & Human Services

Validation Initiative: Why? Opportunity to provide education to vaccine providers Enhanced accountability process NH Immunization Program NH Vaccine Providers

New Hampshire Department of Health & Human Services

Provider Profile - Vaccine Needs NOTE: The following information is used to help the program determine how much vaccine will be needed in 2012. This information should not be estimated, but rather based on patient billing, doses administered, or scheduling data. New providers may estimate their 2012 vaccine need based on the best available patient information.

Please note: Beginning in January 2012, upon request by the NHIP, vaccine providers must make available all documentation validating how the practice developed their most current patient enrollment information. This documentation may include 1) electronic medical record reports: 2) doses administered data; 3) patient chart audits; or 4) other methods approved by the NHIP.

Instructions for filling out this page: 

Only use whole numbers – no percentages.

 Your business office will have the number of patients enrolled in Medicaid, uninsured, American Indian/Alaska Native, and underinsured.

New Hampshire Department of Health & Human Services

Part B. Of the total number in each age group entered above, how many children are expected to be eligible for the Vaccines for Children (VFC) program by the following categories?