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 / STD clinic / Birthing Hospital / Private Hospital / PROVIDERS PRACTICING AT THIS FACILITY / /
IndustryTerm
immunization services / insurance payment / /
MedicalCondition
Hepatitis A / HIV / vaccine preventable disease / HPV / hepatitis B / Polio / Varicella / influenza / /
Immunization Program Section Chief / VFC coordinator / Governor / COORDINATOR / pharmacist / Medical Director / administrator / Private / health department administrator / Data logger / /