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2016 <br />WASHINGTON STATE DEPARTMENT OF HEALTH <br />OFFICE OF IMMUNIZATION AND CHILD PROFILE <br />Organization Name: KITTITAS VALLEY HEALTHCARE <br />Clinic/Facility Name: KITTITAS COUNTY PUBLIC HEALTH <br />PIN: 163000 <br />Provider/Practice Profile <br />Provider Population based on patients seen during the previous 12 months. Report the number of children who received <br />vaccinations at your facility, by age group. Only count a child once based on the status at the last immunization visit, <br />regardless of the number of visits made. The following table documents how many children received VFC vaccine, by <br />category, and how many received non-VFC vaccine. <br />VFC Vaccine Eligibility Categories <br /># of children who received VFC Vaccine by Age Category <br /><1 Year <br />1-6Years <br />7-18Years <br />Total <br />VFC eligible— Medicaid/Medicaid Managed Care <br />10 <br />34 <br />48 <br />92 <br />VFC eligible— Uninsured <br />1 <br />9 <br />16 <br />26 <br />VFC eligible— American Indian/Alaskan Native <br />0 <br />0 <br />0 <br />0 <br />VFC eligible— underinsured at FQHC/RHC/ <br />deputized provider <br />0 <br />3 <br />8 <br />11 <br />CHIP <br />0 <br />0 <br />0 <br />0 <br />Other Underinsured <br />0 <br />0 <br />0 <br />0 <br />Total VFC: <br />11 <br />46 <br />72 <br />129 <br />Non-VFC Vaccine Eligibility Categories <br /># of children who received non-VFC Vaccine by Age Category <br /><1 Year 1-6 Years <br />7-18Years <br />Total <br />Not VFC Eligible <br />0 5 <br />18 <br />23 <br />Private Insurance (WAA01) <br />5 31 <br />51 <br />87 <br />Total Non-VFC: <br />5 36 <br />69 <br />110 <br />Total Patients (must equal sum of Total VFC + Total <br />Non-VFC) <br />16 82 <br />141 <br />239 <br />What type of data was used to determine the provider population? (Check all the apply) <br />L] Benchmarking ❑ Medicaid Claims O; Doses Administered <br />Provider Encounter Data Q Billing System go Washington State Immunization Information System <br />C] Other -Please Specify: <br />