Complete COVID-19 Provider Agreement and Profile

If you are already enrolled in ImmPRINT, the Provider Agreement and Profile MUST still be completed. Utilize and follow the instructional video(s): “Initial Site Enrollment” and “COVID-19 Special Project Enrollment”

COVID-19 Provider Agreement Requirements Summary

1. Administer vaccine in accordance with all CDC requirements and CDC’s Advisory Committee on Immunization Practices (ACIP)
2. Enter all COVID-19 vaccine administered doses required data elements within 24 hours into ImmPRINT. Please include the patient’s email for second dose reminder
3. Preserve administration records for a minimum of 3 years
4. Do not sell or seek reimbursement for COVID-19 vaccine and any adjuvant, syringes, needles, or other constituent products and ancillary supplies provided by federal government
5. Administer COVID-19 vaccine regardless of the vaccine recipient’s ability to pay COVID-19 vaccine administration fees
6. Provide EUA fact sheet or Vaccine Information Statement (VIS) before administering COVID-19 vaccine
7. Conduct COVID-19 vaccination services in compliance with CDC’s Guidance, including https://vaccinefinder.org/  daily inventory, for Immunization Services During the COVID-19 Pandemic for safe delivery of vaccines.
8. Comply with CDC requirements for COVID-19 vaccine management
   1. Store an handle COVID-19 vaccines properly, maintain cold chain conditions, and chain of custody at all times
   2. Monitor vaccine-storage-unit temperatures at all times.  ADPH will provide when available for ultra-cold vaccine
   3. Comply with AL’s Immunization Division guidance for temperature excursions supplied by IMM field staff
   4. Monitor and comply with COVID-19 vaccine expiration dates
9. Report the number of doses of COVID-19 vaccine and adjuvants that were unused, spoiled, expired, or wasted in ImmPRINT when available.
10. Comply with all federal instructions and timelines for disposing COVID-19 vaccine and adjuvant when available
11. Report moderate and severe adverse events following vaccination to the Vaccine Adverse Event Reporting System (VAERS),  https://vaers.hhs.gov/esub/index.jsp.
12. Provide a completed COVID-19 vaccination record card to every COVID-19 vaccine recipient as a reminder for second dose if applicable

Ordering Vaccine

Utilize and follow the instructional video titled Vaccine Ordering Management System on the ADPH website (link below)

Resources

1. Link to the ImmPRINT roadmap:  https://www.alabamapublichealth.gov/immunization/assets/immprint_registration_roadmap.pdf
2. COVID-19 Vaccine Expiration Date Tracking Tool: https://www.alabamapublichealth.gov/immunization/assets/covid19_pfizervaccine_expiration_tracking.pdf
3. View the CDC video “COVID-19 Vaccine Training Module- General Overview of Immunization Best Practices for Healthcare Providers”    https://www2.cdc.gov/vaccines/ed/covid19/
4. View the ADPH Video “ Ordering COVID-19 Vaccine”   https://youtu.be/IJ2FgLcAtF4
5. Administrative cost for vaccine for the uninsured will be covered by HRSA – https://www.hrsa.gov/CovidUninsuredClaim and FAQs for COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing, Treatment and Vaccine Administration | Official web site of the U.S. Health Resources & Services Administration (hrsa.gov)