Tasmanian Vaccination Service

Provider Agreement

Draft Version: 1.0

Date: 18 October 2013

Service Provider Agreement

Tasmanian Vaccination Service Provider Agreement between

Vaccination Service Provider

Name of Practice/Clinic/Local Government/Other Organisation:

Name of CEO, Principal Doctor/s or Local Government General Manager:

and

The Department of Health and Human Services

DECLARATION by Vaccination Service Provider
I declare that I am authorised to act on behalf of the above vaccination service provider organisation. I accept in full the terms and conditions of the Tasmanian Vaccination Distribution scheme.
Name / Position
Signature / Date
Signature of witness / Name of Witness
Witness Address / Witness Occupation
Signed for the Department of Health and Human Services
Name / Position
Signature / Date
Signature of witness / Name of Witness
Witness Address / Witness Occupation

Provider Details

Vaccination Service Provider
Name:
Account Number:
Type of Vaccination Service Provider:
(e.g. General practice, or Local Government)
Name and title of vaccine accountable officer:
(e.g. Practice Principal, Business Owner or Local Government General Manager)
Approved Recipient
Name of person ordering or authorising the ordering of vaccines:
Registered Medical Practitioner Authorised Nurse Immuniser or Pharmacist(please tick)
A Tasmanian Vaccination Service Provider Authorisation to Order has been completed if applicable to this practice: Yes No
Contact Details
Postal Address:
Postcode:
Address for Vaccine Delivery:
Opening Hours / Special Instructions:
Email address for primary person responsible for ordering vaccine:
Telephone: / Fax:

TERMS AND CONDITIONS relating to the Tasmanian Vaccination Distribution Scheme

The National Immunisation Program

Immunisation is a simple, safe and effective way of protecting people against harmful diseases before they come into contact with them in the community. Immunisation not only protects individuals, but also others in the community, by reducing the spread of disease.
The Immunise Australia Program aims to increase national immunisation rates by funding free vaccination programs, administering the Australian Childhood Immunisation Register and communicating information about immunisation to the general public and health professionals.

The Immunise Australia Program implements the National Immunisation Program (NIP) Schedule which currently includes vaccines against a total of 15 diseases in Tasmania. The Australian Government provides funding for:

  • State and Territory Governments to obtain vaccines listed on the National Immunisation Program (NIP) in accordance with the list of Designated Vaccines.
  • Medicare Australia for the Australian Childhood Immunisation Register (ACIR);
  • The Victorian Cytology Service for the administration of the National HPV Vaccination Program Register.

Vaccines on the National Immunisation Program (NIP) are issued to Tasmanian Vaccination Providers to allow providers to take every opportunity to vaccinate eligible children and adults.

Terms and Conditions relating to the Tasmanian Vaccination Distribution Scheme

  1. The Principal Officer signing the agreement is responsible and accountable for this agreement.
  2. In accordance with the Tasmanian Poisons Act 1971, only a registered Medical Practitioner, authorised Nurse Immuniser or Pharmacistis an approved recipient eligible to order vaccines supplied under the National Immunisation Program. This authority can be passed to another suitable person e.g. a Practice Nurse or Environmental Health Officer. If authority is given, a Tasmanian Vaccination Service Provider Authorisation to Order will be completed and retained by the Service Provider.

See Attachment 1 and available at

  1. Vaccines supplied under National Immunisation Program to the provider can only be used as per the Free Vaccines Supplied by DHHS Tasmania and their Indications for Use document supplied by the Department of Health and Human Services each year.

See Attachment 2 and available at

  1. Vaccines provided through the government funded National Immunisation Program will be provided to Australian Medicare card holders only.
  2. Vaccination programs will be conducted as per the guidelines in the current version of The Australian Immunisation Handbook.
  1. Vaccination programs utilising Authorised Nurse Immunisers not under the direct supervision of a Medical Practitioner must have a Program Approval signed by the Director of Public Health. It is the responsibility of the provider to ensure that this is renewed every two years.

Download the Guidelines for Providers Employing Nurse Immunisers application for a Program Approval at

  1. Any changes in ownership of a practice, change in Practice Principal or Manager or movement of the authorising Medical Practitioner or Nurse Immuniser in or out of the practice must be notified to the Immunisation Section, Communicable Diseases Prevention Unit using a Change of Details form.

See Attachment 3 and available at

  1. Approved Tasmanian Immunisation Providers will enter vaccine orders on to BioCSL’ s electronic web link ordering and distribution system with support from CDPU as necessary. The Web Based Ordering System is accessed at using a supplied log in and password.
  1. In most cases vaccine requests should include all required funded vaccines for the coming month. Stock on hand quantities of vaccines remaining in refrigerator/s must be advised at the time of ordering as requested. Additional vaccine deliveries within a month may not be authorised by CDPU.
  1. Vaccines will be stored as per the current edition of The National Vaccine Storage Guidelines Strive for 5, available at
  2. and any other relevant information published by the Department of Health and Ageing (Canberra) or the Department of Health and Human Services (Tasmania).
  3. Each dose of vaccine administered to an eligible person will be notified promptly to the Australian Childhood Immunisation Register (ACIR) or the National HPV Vaccination Program Register as applicable.
  4. Vaccines delivered to a provider become the responsibility of the provider, and in the event of vaccine loss due to a cold chain interruption, the provider may be asked to reimburse the costs of the vaccine to the Department of Health and Human Services. It is suggested that providers obtain insurance to cover this potential cost.
  5. Immunisation staff from the Communicable Diseases Prevention Unit may undertake a site visit to providersto perform a cold chain audit, or collaborate with Tasmanian Medicare Local to arrange for a Practice visit.
  6. Information requested by the Department of Health and Human Services (Tasmania) relating to vaccine distribution and immunisation coverage will be provided in the time frame requested.
  7. If vaccine is affected by a Cold Chain breach (below 2°C or over 8°C), you must contact the Immunisation Section, CDPU on 1800 671 738 prior to using or discarding the affected vaccines.

Attachment 1

Tasmanian Vaccination Service - Authorisation to Order

1 July 2013- 30 June 2014

I, ______

Registered Medical Practitioner / Authorised Nurse Immuniser (cross out non applicable), providing services for______(Name of service)

authorise

______(name) ______(position)

______(name) ______(position)

to order on my behalf from the Department of Health and Human Services the following National Immunisation Program vaccines, consistent with the quantities specified:

Product / Brand Names / Maximum doses to order
Influenza / Fluvax / Vaxigrip / Fluarix
Influenza Junior / Vaxigrip Junior
dTpa / Boostrix
HPV / Gardasil
Hib / Hiberix
DTPa/Hib/hepB/IPV / Infanrix hexa
DTPa/IPV / Infanrix IPV
Meningococcal C / Meningitec / NeisVacC
Pneumococcal / Pneumovax
Pneumococcal / Prevenar
MMR / Priorix
Rotavirus / Rotarix
Varicella / Varilrix / Varivax
MMR /Varicella
Hepatitis B Paed / HBVaxII Paediatric
Hepatitis B Adult / HBVaxII Adult
Meningococcal C/ Hib
Other:

Signed______Date ______

If any of the parties named cease association with the Vaccination Service Provider, this delegation must be updated.

Please retain this document at your practice.

Attachment 2

Department of Health and Human Services

Population Health

FREE VACCINES SUPPLIED BY DHHS TASMANIA AND THEIR INDICATION FOR USE 2013

VACCINE / INDICATION FOR USE
Adult Diphtheria & Tetanus
(ADT Booster®) / Catch-up immunisation for 10 years of age and over, who have not had a primary course of diphtheria and tetanus, or have an incomplete history of diphtheria and tetanus immunisations
Call DHHS to discuss before ordering
Adult/Adolescent Diphtheria, Tetanus & acellular Pertussis (Boostrix®) / Local councils offer Boostrix® in Year 7 of secondary school
Catch-up Year 9 (2013-14) and 10 (2013)
GPs are supplied a small quantity of Boostrix® for students who did not receive the vaccine through the school program
Diphtheria, Tetanus, Acellular Pertussis, Inactivated Polio, Hepatitis B and Hib
(Infanrix Hexa®) / 2, 4 and 6 months of age
Catch-up to 9 years of age (inclusive)
Diphtheria, Tetanus, Acellular Pertussis & Inactivated Polio
(Infanrix IPV®) / 3 ½ - 4 years of age
Catch-up to 9 years of age (inclusive)
Inactivated Poliomyelitis
(IPOL®) / Individuals (aged 10 years and older) who are unimmunised or incompletely immunised for poliomyelitis
Call DHHS to discuss before ordering
Meningococcal C/Haemophilus influenzae type b
(Menitorix®) / 12 months of age
Hepatitis B adult
(H-B Vax II Adult®) / 12 to 13 years of age if not previously received – 2013 only
Hepatitis B paediatric
(H-B Vax II Paediatric®) / Infants at birth and within 7 days of birth
12 months of age booster dose if born less than 32 weeks gestation or less than 2000 g birth weight
Catch-up to 9 years of age (inclusive)
Human Papilloma Virus
(Gardasil®) / Year 7 school program (12-13 years of age only)
Year 9 boys in school program (14 to 15 years of age) - time-limited 2013 and 2014
Year 9 boys in school program (14 to 15 years of age) - time-limited 2013 and 2014
Influenza
(Vaxigrip®/Fluvax®/Fluarix®) / 6 months of age and over with conditions predisposing to severe illness following influenza infection
15 years of age and over for Aboriginal and Torres Strait Islander people
All pregnant women during any stage of pregnancy
65 years of age and older
Measles, Mumps, Rubella
(Priorix®/M-M-R II®) / 12 months and 4 years of age
Measles, Mumps, Rubella / Varicella
(Priorix®-Tetra) / 18 months of age
Childhood Pneumococcal
(Prevenar 13®) / 2, 4, & 6 months of age
12 months of age booster dose if underlying medical risk factors including born less than 28 weeks gestation
Catch-up if less than 5 years of age
Pneumococcal
(Pneumovax 23®) / 4 to 5 years of age with underlying medical risk factors includes born less than 28 weeks gestation
15 to 49 years of age for Aboriginal and Torres Strait Islander people with underlying medical risk factors
50 years of age and over for Aboriginal and Torres Strait Islander people
65 years of age and over
Rotavirus
(Rotarix®) / 2 and 4 months of age
No catch-up for this vaccine outside this age group
Varicella (chickenpox)
(Varilrix® or Varivax®) / Year 7 school program (12-13 years of age only) if no history of disease

Attachment 3

Department of Health and Human Services
Communicable Diseases Prevention Unit
Immunisation section /

Tasmanian Vaccine Service Provider Change of Details Form

Service Provider Details
Account Number:
Business Name:
New Business Name:
Existing Practice Principal/s, CEO or Manager:
New owner, Practice Principal/s, CEO or Manager:
(A new Tasmanian Vaccination Service Provider Agreement should be completed and forwarded to the Communicable Diseases prevention Unit)
Approved Vaccine Recipient (Registered Medical Practitioner or Authorised Nurse Immuniser)
Existing Approved Vaccine Recipient:
New Approved Vaccine Recipient / Name:
AHPRA: / Expiry:
(A new Vaccine Service Provider Authorisation to Order should be completed and retained by your service if the new Approved Vaccine Recipient will allow another person to order on their behalf)
Address
New address (indicate if business and/or delivery)
Street:
Suburb: / Post Code:
Opening Hours
New opening hours
Morning / Afternoon
Opening / Closing / Opening / Closing
Monday
Tuesday
Wednesday
Thursday
Friday
Please complete any changes and email to

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Tasmanian Vaccination Service Provider Agreement