Provider IWeb Enrollment Applications

Practice Name

Pre-populated with the name of the practice. This field is required.

Address

Street Address

Enter or modify the first line of the street address. This field is required.

Street Address 2

Enter the second line of the street address, if necessary.

City

Enter the city name. This field is required.

State

Select the state from the drop-down list. This field is required.

Zip Code

Enter the zip code. This field is required.

Phone

Enter the phone number. An error message will appear if a phone number with repeating digits is entered (e.g., 111-1111). This field is required.

Phone Extension

Enter the extension number associated with the phone number.

Fax

Enter the fax number.  An error message will appear if a phone number with repeating digits is entered (e.g., 111-1111).

Office Manager

Enter the name of the office manager or contact person.

Email Address

Enter the email address. This field is required.

Mailing Address (if different from above)

Street Address

Enter or modify the first line of the mailing street address.

Street Address 2

Enter the second line of the mailing street address, if necessary.

City

Enter the city name.

State

Select the state from the drop-down list.

Zip Code

Enter the mailing zip code.

Facility Type

Select the Facility type from the drop-down list.

Phone Extension

Enter the extension number associated with the phone number.

Site Type

Select a site type from the drop-down list. Examples:

• Community Health Center
• Health Maintenance Organization (Public or Private)
• Hospital
• School
• WIC
• Dentist

Provider Agreement Facility Type

Select the Facility type for the provider agreement. If Other is selected, a description must be entered in the next field.

Provider Agreement Facility Type Other

Enter a description for Other in the previous field. This field is required if Other is selected in the previous field.

Automatic Ownership Blocked

If this option is selected, the Organization (IRMS) cannot own patient and vaccination records. An Organization (IRMS) with blocked ownership does not display in the drop-down list on the patient demographics screen.  When adding an administered vaccination, the Organization (IRMS) on the patient demographics screen is not populated with the Organization (IRMS) from the administered shot.

Comments

Enter any other information to keep on file for the Organization (IRMS). Maximum of 254 characters.

Local Approval Organization (IRMS)

Select the appropriate jurisdictional Organization (IRMS) for approving vaccine orders. This option is only visible if the user has state or local order approver permission.

Is Local Approver

Select this option if the Organization (IRMS) is a local approver. This option is only visible if the user has state or local order approver permission.

Is State Approver (Distributor)

Select this option if the Organization (IRMS) is a state approver (distributor). This option is only visible if the user has state or local order approver permission.

Is Depot

Select this option if the Organization (IRMS) is a vaccine depot. Only one Organization (IRMS) can have this option enabled. If this option is selected (enabled), the Is State Approver and Is Local Approver options must be disabled.

Is Vaccine Return Depot

Select this option if the Organization (IRMS) is a vaccine return depot. Multiple Organizations can be designated as vaccine return depots. If the Registry has multiple Organizations with this option enabled, a required field appears on the vaccine return page to allow the user to select the correct vaccine return Organization (IRMS). This option is only visible if the user has state or local order approver permission.

The Organization (IRMS) that is designated as the return depot should not be used for other vaccine order functions. All return depot Organizations should be dedicated to that purpose.

Is Vactrack User

Select this option if the Organization (IRMS) submits data to the system but is not a VFC provider or VOMS user. The reason for this is so that there is a way to pull this information for providers that are not captured in the VFC information distribution on the provider contact report.

Provider Agreement (displays when enabled in Administration properties)

Allow Provider Agreements

Select this option if the Organization (IRMS) is able to allow provider agreements. This option only appears if the Administration > Properties > Vaccine Management option Enable Provider Agreement Features is selected.

If Allow Provider Agreements is selected/enabled, the Organization (IRMS) can use the Orders/Transfers > Search Agreement feature to view/approve provider agreements. The provider agreement fields are linked at the Organization (IRMS)/Facility level associated with the VFC PIN. The Organization (IRMS) or Facility Maintenance page updates when the agreement is approved.

Shipping Address Street

Enter the first line of the address where the vaccine order shipments will be sent/shipped. The user must have state or local order approver permission in order to see this option.

Shipping Address Street 2

Enter the second line of the address where the vaccine order shipments will be sent/shipped. The user must have state or local order approver permission in order to see this option.

Shipping Address City

Enter the city name where the vaccine order shipments are to be sent. The user must have state or local order approver permission in order to see this option.

Shipping Address State

Select the state where the vaccine order shipments are to be sent. The user must have state or local order approver permission in order to see this option.

Shipping Address County

Select the county, parish, borough or census area for the vaccine order shipments. The user must have state or local order approver permission in order to see this option.

Shipping Address Zip

Enter the zip code for the vaccine order shipments. The user must have state or local order approver permission in order to see this option. If multiple zip codes have been entered for the city, the Select Zip Code dialog box will appear. Otherwise, the zip code may be automatically populated.

Shipping Instructions

Enter any special shipping instructions, including a contact person's name, phone, fax, and/or email address. The user must have state or local order approver permission in order to see this option.

Mailing Address Street

Enter the first line of the mailing address where correspondence for vaccine order shipments are to be mailed. The user must have state or local order approver permission in order to see this option.

Mailing Address Street 2

Enter the second line of the mailing address where correspondence for vaccine order shipments are to be mailed. The user must have state or local order approver permission in order to see this option.

Mailing Address City

Enter the city for the mailing address where correspondence for vaccine order shipments are to be mailed. The user must have state or local order approver permission in order to see this option.

Mailing Address State

Select the state for the mailing address where correspondence for vaccine order shipments are to be mailed. The user must have state or local order approver permission in order to see this option.

Mailing Address County

Select the county, parish, borough, or census area for the mailing address where correspondence for vaccine order shipments are to be mailed. The user must have state or local order approver permission in order to see this option.

Mailing Address Zip

Enter the zip code for the mailing address where correspondence for vaccine order shipments are to be mailed. The user must have state or local order approver permission in order to see this option. If multiple zip codes have been entered, the Select Zip Code dialog box appears. Otherwise, the zip code may be automatically populated.

Contact Details

Type 1 (and 2-5)

Select a contact type. Examples: Vaccine Delivery, Mailing, Facility.

Contact First Name 1, Middle Initial 1 and Last Name 1 (and 2-5)

Enter the name of the contact person.

Phone Number 1 (and 2-5)

Enter the phone number for this contact.

Phone Number Extension 1 (and 2-5)

If applicable, enter the phone extension for this contact.

Fax Number 1 (and 2-5)

Enter the fax number for this contact.

Email Address 1 (and 2-5)

Enter the email address for this contact.

Vaccine Management

Certifying Provider

Enter the name of the certifying provider. This is used to support the depot using VOMS. This field is populated from the provider agreement with the same VFC PIN.

Certifying Provider Phone

Enter the phone number for the certifying provider. This is used to support the depot using VOMS. This field is populated from the provider agreement with the same VFC PIN.

Certifying Provider Fax

Enter the fax number for the certifying provider. This is used to support the depot using VOMS.

Certifying Provider Email

Enter the email address for the certifying provider. This is used to support the depot using VOMS.

Agreement Signatory Name

Enter the name of the agreement signatory.

Agreement Signatory Title

Enter the title of the agreement signatory.

Original VFC Cert Date

Enter the original VFC certification date.

Current Certification Date

Enter the date of the current certification.

Freezer average temperature of 5 ° F or colder

Select this option to indicate that the average temperature of the freezer is 5 ° F or colder, if applicable.

Separate, insulated freezer door

Select this option to indicate that there is a separate insulated freezer door on the freezer, if applicable.

Freezer Measuring Device

Select the device used to measure the freezer temperature. The choices are:

• Standard Fluid Filled
• Continuous Recording
• Min Max
• Dial
• Digital
• Digital Data Logger
• Other - enter the description in the next field (mandatory if Other is selected)

   Other Device

If the Freezer Measuring Device is Other, enter a description here (required).

Allow Online Orders

Select this option is the Organization (IRMS) can send vaccine orders online. The user must have state or local order approver permission in order to see this option. Once this option is enabled, the VFC PIN field is required.

Allow Vaccine Transfers

Select this option if the Organization (IRMS) is able to allow vaccine order transfers. The user must have state or local order approver permission in order to see this option.

Allow Vaccine Returns

Select this option if the Organization (IRMS) is able to allow vaccine returns. The user must have state or local order approver permission in order to see this option.

Default physical inventory on order

Select this option to display the Current Inventory for that Vaccine on the Create Order > Order Details screen for the Physical Inventory column. If selected (enabled), the current inventory displays on the Create Order screen as read-only. This field is used for reconciliation and controls the defaults in the Physical Inventory column on the Create Order page. If not selected (disabled), a blank field displays on the Create Order screen for the user to enter their own quantity. The user must have state or local order approver permission in order to see this option.

Default doses used last month on order

Select this option to display the Default Doses Used Last Month in the Doses Used Last Month column on the Create Order > Order Details screen. If not selected (disabled), a blank field displays on the Create Order screen for the user to enter their own quantity. The user must have state or local order approver permission in order to see this option.

Order Threshold Percent

Enter a numeric value to represent the percentage of orders to reach before placing an order for the Organization/Facility. There is also a registry-wide setting in the Administration properties that is used if a setting is not entered here (see Settings ) . However, this setting overrides the registry-wide setting.

Ordering Frequency

Select the provider's ordering frequency from the drop-down list. Choices are:

• --Select-- (will not validate)
• Annual (calendar year)
• Every six months (month will vary as assigned)
• Every three months (month will vary as assigned)
• Every two months (month will vary as assigned)
• Monthly (1st day of the month to the last day of the month)
• Twice monthly (1st to the 15th and 16th to the last day of the month)

If the Organization (IRMS) does not have an ordering frequency set, the ordering frequency is derived from the registry setting. If there is an IRMS/Facility setting, it will override the registry setting.

If the provider orders more frequently than their ordering frequency, a dialog box appears when the user clicks Submit, stating Your order is outside the assigned order frequency. Your LHJ will have to approve this exception. Select an exception comment from the drop-down menu and click "Submit" to place this order.

Order Timing

Select the timing to provide the ability to record ordering timing on both the Organization (IRMS) and Facility add/update screens. This is not a registry-wide setting. Choices are:

• --Select-- (will not validate)
• 1st to the 15th
• 16th to End of Month

If the provider orders outside their order timing window, a dialog box appears when the user clicks Submit, stating Your order is outside the assigned order timing. Your LHJ will have to approve this exception. Select an exception comment from the drop-down menu and click "Submit" to place this order. The exception comment and exception reason are visible to both local and state approvers and are saved as part of the order history. The submitted order is queued for Manual Review with the exception reason of Outside assigned order timing.

Order Frequency Start Month

Select a month for the start of the order frequency timing. Appears on both the Organization (IRMS) and Facility add/update screens. This is not a registry-wide property setting. Choices are January, February, March, April, May, or June. This field uses the Ordering Frequency field to determine a valid schedule. No order schedule displays for twice monthly, monthly, or annual frequencies.

• Every Two Months - Start Month = January, Schedule = Jan., Mar., May, July, Sep., Nov. / Start Month = February, Schedule = Feb., Apr., June, Aug., Oct., Dec.
• Every Three Months - Start Month = January, Schedule = Jan., Apr., July, Oct. / Start Month = February, Schedule = Feb., May, Aug., Nov. / Start Month = March, Schedule = Mar., June, Sept., Dec.
• Every Six Months - Start Month = Jan., Schedule = Jan., July. / Start Month = February, Schedule = Feb., Aug. / Start Month = March, Schedule = Mar., Sept. / Start Month = April, Schedule = Apr., Oct. / Start Month = May, Schedule = May, Nov. / Start Month = June, Schedule = June, Dec.

If the Organization (IRMS)/Facility does not have an order start date set, the order schedule is not validated.

If the provider orders outside their order schedule, a dialog box appears when the user clicks Submit, stating Your order is outside the assigned order schedule. Your LHJ will have to approve this exception. Select an exception comment from the drop-down menu and click "Submit" to place this order. The exception comment is required for submitted orders only. The exception comment and exception reason are visible to both local and state approvers and are saved as part of the order history. The submitted order is queued for Manual Review with the exception reason of Outside assigned order schedule.

Recommended Quantity Calculation

Select the recommended calculation to use for the recommended quantity (Based on Administered Doses, Based on Order History). This determines how the default quantity is calculated. (The Recommended Quantity default can also be turned off under Administration > Properties > Vaccine Management, which is recommended when there is no data yet.)

If Based on Administered Doses is selected, the Recommended Quantity is rounded off to a whole number divisible by the vaccine Package Size for publicly supplied vaccines.

If Based on Order History is selected and an order is created with an Order Quantity that is more or less than the Order Threshold Percent and Recommended Quantity, an alert displays and the order is queued for Manual Review. Additionally, when using order history, the safety stock is already factored in and does not need to be added separately.

Enable Auto-Receive

Select this option to allow an uploaded McKesson file to populate lot numbers on open orders. If part of an order is missing from the McKesson file, the new order is created upon receipt.

Order Set/Order Type

Select the order set and order type that define the vaccines that the Organization (IRMS) can order from the drop-down list. The user must have state or local order approver permission in order to see this option.

Allow only one brand selection per vaccine

Select this option to require users to select only one vaccine brand.

Require Manual Deduplication for Intra-Organization (IRMS) Merges

Select this option to have the system queue records for Manual Review if a new patient is an exact match to an existing patient within the same Organization (IRMS). If this option is disabled, the current deduplication behavior is applied.

If both the Organization (IRMS) system ID and the medical record number (or Organization patient ID) are the same for the patient, the record is considered to be an update and continues to be processed automatically.

Bypass Dose-Level Accountability

Select this option to activate the business logic that allows providers that do not track their inventory to the patient dose level, to enter the appropriate reconciliation data to record their current physical inventory.

If this option is selected/enabled, the Reconciliation page automatically populates the reason with Matches Physical Inventory. When the physical inventory value is entered and the user tabs out of the field, the reason automatically defaults to the correct add/subtract Matches Physical Inventory reason and all other reasons are removed from the drop-down list.

For example, if a site does not manage inventory in the Registry and does not decrement from inventory by either the electronic import decrementing logic or by selecting the lot during direct data entry, the system does not know the doses used value for the site. In this case, the provider needs to do their own refrigerator count and enter that number, rather than record each inventory adjustment individually. This is needed to simplify data entry and increase participation among sites that are not significant Registry users.

In the Inventory Transaction report, Matches Physical Inventory Plus displays under the Other In transaction type and Matches Physical Inventory Minus displays under the Other Out transaction type. This reason does not display on the Lot Number Maintenance screen or on the regular Reconciliation page.

Upload Temperature Data

Select this option to allow the Organization (IRMS) to upload the cold storage temperature data.

Facility Required for this Organization (IRMS)

Select this option to require users to select a Facility upon login, rather than requiring it at the Registry level. The default setting should be set to Required or Yes for existing Facilities. When enabled, the menus are disabled until a Facility is chosen. Facility Group users are required to select a Facility prior to proceeding.

Click here to select receiving transfer Organization (IRMS) and facilities

This option only appears if the Administration > Properties > Vaccine Management > Limit Organization (IRMS) and Facilities to Receive Transfer option is enabled (selected). If this option is enabled and the Allow Vaccine Transfers option (previous field) is selected, this becomes a required field.

Click this link to open the Select Receiving Transfer Facilities window. Select one or more Organizations/Facilities that can receive vaccine transfers and click the double-chevron (>>) button to transfer them to the Selected box. Click Done when all of the Facilities have been selected.

Once Done is clicked, a validation is performed. If the Allow Vaccine Transfers is selected but no Organizations/Facilities were selected, an error message appears at the top of the screen stating Please select the receiving transfer facilities. If a new Facility is being added, the selected Receiving Transfer Facilities are saved to the database only when the Facility has been created and saved.

Once saved, only the selected Organizations/Facilities are populated on the Create Transfer screen in the Receiving Organization (IRMS) and Receiving Facility drop-down lists.

Add Facility

Select this option, located immediately above the Cancel, Reset and Save buttons, if you want to add a new Facility as your next step. Otherwise, you will be returned to the Organization (IRMS) Maintenance page. You must have state or local order approver permission to see this option.