Public Health Department Clinic / Facility Address / School-Based Clinic / Public Hospital / Rural Health Clinic / FACILITY TYPE / Indian Health Services Clinic / FACILITY INFORMATION Provider’s Name / Facility Name / Each facility / ADDITIONAL PROVIDERS PROVIDERS PRACTICING AT THIS FACILITY / STD clinic / Facility Authorization Request / Birthing Hospital / Private Hospital / PROVIDERS PRACTICING AT THIS FACILITY / /
IndustryTerm
on-line training modules / temperature monitoring equipment / insurance covers / state law / health insurance / on-line training / vaccine distributor / online training modules / /
MedicalCondition
Hepatitis A / HIV / CHD / HPV / Hepatitis B / Polio / Varicella / influenza / /
Advisory Committee on Immunization Practices / Federally Qualified Health Center / Private Hospital / Immunization Service / Community Health Center / STD/HIV Family Planning Juvenile Detention Center Correctional Facility Drug Treatment Facility Migrant Health Facility Refugee Health Facility School / OSDH Immunization Service / Teen Health Center / Public Hospital / Birthing Hospital / Oklahoma State Department / Medicaid / /
Person
Kathy Terry Any / / /
Position
Vaccine Coordinator / Alternate Vaccine Coordinator / pharmacist / MEDICAL DIRECTOR / regional Immunization Field Consultant / General / DIRECTOR OR EQUIVALENT Instructions / VFC VACCINE COORDINATOR / Private / /
OKLAHOMA VFC PROVIDER CHECKLIST CDC Vaccines for Children Operations Guide; Module 2 – Provider Recruitment/ Enrollment The Vaccines for Children (VFC) program was created to increase access to immunizations outside of