VACCINES FOR CHILDREN

PROVIDER PROFILE DIRECTIONS

The following information will help you complete sections M and N of the Provider Profile IMM-26 or sections L and M of the Provider Profile Adults IMM-18. This form is used to enroll and re-enroll with the New Jersey Vaccines For Children (NJVFC) Program. This form should also be updated when the number of children seen in the practice changes significantly.

For example, an update is needed when additional professional staff join the practice, or if the practice is open longer hours and more children are seen as a result. Contact the New Jersey Vaccines For Children Program at (609) 826-4862 if help is needed to complete this form.

Section M on form IMM-26:

Enter the number of all children; both NJVFC eligible and those with private health insurance who are anticipated to receive vaccination in the coming year. Enter the number of children by age ranges; less than 1 year old, 1 to 6 years old and those 7 to 18 years old.

Section N form IMM-26 or Section M on form IMM-18:

Enter only the number of NJVFC eligible children (see definition below) who are anticipated to receive vaccination in the coming year. Enter the children by age ranges; less than 1 year old, 1 to 6 years old and those 7 to 18 years old and how the children in each age range are NJVFC eligible. Medicaid, NJ FamilyCare, uninsured, American Indian/Alaskan Native or Underinsured (for use by Federally Qualified Health Centers Only).

The following sources provide a reasonably accurate estimate of the number of NJVFC eligible children to enter in “Section N” of the Provider Profile. Use one of the following two formulas:

  1. Total the number of children from Medicaid and FamilyCare insurance capitation lists.

Add to this number those children without private insurance and children who are Alaskan or American Indian, no matter the insurance status. Sort by age.

Subtract the percentage of “no-show” children typical for the practice.

  1. Vaccine doses administered or ordered in the prior year. Divide the number of doses in a vaccine series to arrive at the number of children seen in the three age groups.

The total number of vaccine doses administered in the prior year can be found in the New Jersey Immunization Information System.

The number of vaccine doses ordered in the past year is found in order confirmations and packing slips from NJVFC vaccine orders.

Created on 6/8/2011

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