Provider Profile

The Provider Profile page captures the organization's facility information, the vaccines offered, provider population and the type of data used to determine the Provider Population details.

This section displays the facility name and VFC PIN of the facility. It also captures the Provider Type, Specialty, Facility Type and Enrollment Type.

Field Name	Description
Facility Name	Name of the facility. Pre-populated with the existing facility name. Displayed as read only.
VFC PIN	VFC PIN number of the facility. Pre-populated with existing VFC PIN. Displayed as read only.
Provider Type	Provider type of the facility. Drop down lists all organization/provider types for vaccine organizations. The field is pre-populated with current provider type. Verify the provider type is correct or select a new provider type from the list. It should be rare that the provider type needs to change. Click on the Provider Type link on the page to see a popup window of with a list and description of each provider type. Note: The 'IRIS' Org Types section is for non-vaccine providers cannot be selected as a valid provider type for VFC enrollment. Note: Changing Provider Type or Enrollment Type will display an alert "Warning: Changing Facility Type will also clear all information saved previously in this page. Are you sure you want to Continue?" and when 'Ok' is clicked, the change is applied and the form data is cleared, and when 'Cancel' is clicked, no change is made.
Specialty	Type of provider specialty(ies) available at the facility. You can select from the available options with a checkbox. Multiple specialties may be selected. Click on the Specialty definitions link on the page to see a popup window of with a list and description of each Specialty.
Facility Type	Select one of the following to indicate the facility funding source: Private Facility (privately funded entity; non -governmental) Public Facility (publicly funded or government entity) Combination (funded with public and private funds). Only one checkbox may be selected.
Is this facility a mobile facility, or does this facility have mobile units?	Select Yes, No or NA (not applicable) to indicate if facility is part of a hospital/healthcare system. Only one checkbox may be selected.
Is this facility a mobile facility, or does this facility have mobile units?	Select Yes or No to indicate if facility has mobile units. *A mobile unit is a dedicated vehicle with a primary purpose of provider medical services (e.g. immunization services). Only one checkbox may be selected.
Enrollment Type	The type of enrollment (Vaccines for Children Provider or Birth Dose Hospital). If the provider type is Birthing Hospital the enrollment type is selected as Birth Dose Hospital by default. Otherwise the Vaccines for Children Provider is selected as the enrollment type by default. When the Facility Type is changed, the enrollment type is changed as per the enrollment default value selections. Note: Changing Provider Type or Enrollment Type will display an alert "Warning: Changing Facility Type will also clear all information saved previously in this page. Are you sure you want to Continue?" and when 'Ok' is clicked, the change is applied and the form data is cleared, and when 'Cancel' is clicked, no change is made.

The Vaccines Offered section allows the Specialty Providers to select the vaccines they offer. At least one of the below options need to be checked. The selection(s) made as part of the previous year's re-enrollment will be selected by default.

This sections displays the Provider Population based on patients (who are less than or equal to 18Y of age) seen during the previous 12 months. Two tables display the VFC and Non-VFC population for a facility. The population is grouped into four age groups '< 1 Year', '1-6 Years', and '7-18 Years'. The total for each eligibility criteria is displayed using the column 'Total'. The Provider Population can be edited using the 'Edit' button available below the tables and the changed values are saved when this page is saved.

Column Name	Description
Medicaid	Count of patients who received the vaccine with VFC eligibility Medicaid for each age cohort.
Uninsured	Count of patients who received the vaccine with VFC eligibility Uninsured for each age cohort.
American Indian/Alaska Native	Count of patients who received the vaccine with VFC eligibility American Indian/Alaska Native for each age cohort.
Underinsured FQHC/RHC¹	Count of patients who received the vaccine with VFC eligibility Underinsured FQHC/RHC for each age cohort. Note: This row can only be edited when the Facility Type is 'FQHC/RHC (Community/Migrant/Rural)' Or 'Public Health District Clinic' Or 'Public Health District Clinic as agent for FQHC/RHC-deputized'.
Total VFC	Total patients in each age cohort.

Column Name	Description
Have Health Insurance (that covers vaccines)	Count of patients who have health insurance (VFC Ineligible and reside in Idaho or Washington) for each age cohort. Note: This row can only be edited when the Facility Type is NOT 'Birthing Hospitals'.
Other Underinsured² (Non-Idaho resident)	Total count of patients who satisfy the below conditions for each age cohort. - Patients that are VFC Ineligible and do not reside in Idaho or Washington - Patients that are Underinsured FQHC/RHC for organizations that are NOT of type 'FQHC/RHC (Community/Migrant/Rural)' Or 'Public Health District Clinic' Or 'Public Health District Clinic as agent for FQHC/RHC-deputized'
Birth Dose (Hep B) - Other Insured at Birthing Hospitals Only³	Count of patients that are VFC Ineligible for the facility type 'Birthing Hospital' for each age cohort. Note: This row can only be edited when the Facility Type is 'Birthing Hospital'.
Total Non-VFC	Total Non-VFC patients in each age cohort.
Total Patients (must equal sum of Total VFC + Total Non-VFC)	Total patients in each age cohort. This will be a total of Total VFC and Total Non-VFC in each age cohort.

1. Enter the Begin Date and End Date. Click the Update button to search within IRIS for patient counts based on new immunizations for your organizations within IRIS.

2. You may edit the above table with numbers you feel more accurately reflect the population you will serve in the next 12 months. Use the "Edit" button to change the values in the tables if needed.

¹Underinsured includes children with health insurance that does not include vaccines or only covers specific vaccine types. Children are only eligible for vaccines that are not covered by insurance.

In addition, to receive VFC vaccine, underinsured children must be vaccinated through a Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC) or under an approved deputized provider. In Idaho, only the Public Health Districts have a written agreement with an FQHC/RHC and IIP in order to vaccinate these underinsured children.

²Other Underinsured are children that are underinsured but are not eligible to receive federal vaccine through the Immunization Program because the provider or facility is not a FQHC/RHC or a deputized provider (Public Health Districts). These children may be served if vaccines are privately purchased and provided to cover these non-VFC eligible children.

³Birth Dose of hepatitis B administered at the birthing facility to infants that are non-Idaho, non-Washington residents who have a health insurance benefit.

Note1: The time window represented by the Begin Date and End Date cannot exceed a year.

Note2: The time window as well as the data updated/entered in the tables are saved when the provider profile is saved.

This section captures the type of data that are used to determine the VFC and Non-VFC provider population in the above section. At least one option to be checked for this section and the options 'IIS (IRIS)' and 'Doses Administered' are selected by default.

Button	Description
	When Save is clicked, all fields are validated. If there are errors, the error message are displayed and the form is not saved and when there are no errors, the provider profile is saved. - If information is saved while not in Enrollment Period and the provider VFC Status is Active (i.e. provider is changing information but not re-enrolling), the Next and Back buttons will be enabled, however, the Submit button will not be displayed. The message 'Saved successfully and submitted to the Idaho Immunization Program' will be displayed. An e-mail notification will be sent IIP with list of changes made since the last save of Provider Profile. - If information is saved during Enrollment Period and Organization’s VFC Status is Active, Pending or Suspended OR if outside the enrollment period and the Organization’s VFC Status is Pending or Suspended (i.e. provider is re-enrolling) and if the user has not saved the Provider Agreement, Provider Profile and Brand Choice after the current Enrollment Period has started, the message 'The re-enrollment is not complete. Please review and save the Provider Agreement, Provider Profile, and Brand Choice. Once all three forms have been saved, the information must be submitted to the medical director or equivalent for signature.' will be displayed at the end of the page. The Submit button will not be displayed. The Next and Back buttons will be enabled. - If information is saved during Enrollment Period and Organization’s VFC Status is Active, Pending or Suspended OR if outside the enrollment period and the Organization’s VFC Status is Pending or Suspended (i.e. provider is re-enrolling) and if the user has saved the Provider Agreement, Provider Profile and Brand Choice after the current Enrollment Period has started, the message 'Provider Agreement, Provider Profile and Brand Choice have all been saved successfully for VFC Re-enrollment. Click Submit to notify the medical director the forms are ready for review and signature.' will be displayed at the end of the page. The Submit button will be displayed. The Next and Back buttons will be enabled.
	The Submit button will be visible only when if information is saved during Enrollment Period and Organization’s VFC Status is Active, Pending or Suspended OR if outside the enrollment period and the Organization’s VFC Status is Pending or Suspended (i.e. provider is re-enrolling) and if the user has saved the Provider Agreement, Provider Profile and Brand Choice after the current Enrollment Period has started. When Submit is clicked, all fields are validated. If there are errors, the error message are displayed and the form is not saved and when there are no errors, the provider agreement is saved and the message 'Submitted to your Medical Director for review and signature.' is displayed. An e-mail notification will be sent to Medical Director or Equivalent notifying that the VFC Re-enrollment form is submitted for review and sign.
	The Print will be enabled after the page is saved. When Print is clicked, the Provider Profile form (Facility Information including the vaccine delivery hours, Facility Type, Vaccines Offered, Provider Population and Type of data used to determine the Provider Population.) is printed as a PDF file.
	The Next will be enabled after the page is saved. When Next is clicked, the user will be taken from the Provider Profile page to the Vaccine Brand Choice page.
	When Back is clicked, the user will be taken from the Provider Profile page to the Provider Enrollment page.
	When Cancel is clicked, any changes that have been made since the last Save, will be cancelled.

A "Specialty Provider" is defined as a provider that only serves:
1. a defined population due to the practice specialty (e.g. OB/GYN; STD clinic; family planning)
2. a specific age group within the general population of children ages 0-18. Local health departments and pediatricians are not considered specialty providers. The Idaho Immunization Program (IIP) has the authority to designate VFC providers as specialty providers.