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2016 <br />WASHINGTON STATE DEPARTMENT OF HEALTH <br />OFFICE OF IMMUNIZATION AND CHILD PROFILE <br />Organization Name: KITTITAS VALLEY HEALTH CARE <br />Clinic/Facility Name: KITTI TAS 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 ~ 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 1-6 Years 7-18 Years Total <br />VFC eligible-Medicaid/Medicaid Managed Care 10 34 48 92 <br />VFC eligible-Uninsured 1 9 16 26 <br />VFC eligible-American Indian/Alaskan Native 0 0 0 0 <br />VFC eligible-underinsured at FQHC/RHC/ 0 3 8 11 <br />deputized provider <br />CHIP 0 0 0 0 <br />Other Underinsured 0 0 0 0 <br />TotaIVFC: 11 46 72 129 <br />Non-VFC Vaccine Eligibility Categories <br /># of children who received non-VFC Vaccine by Age Category <br /><1 Year 1-6 Years 7-18 Years Total <br />Not VFC Eligible 0 5 18 23 <br />Private Insurance (WAA01) 5 31 51 87 <br />Total Non-VFC: 5 36 69 110 <br />Total Patients (must equal sum of Total VFC + Total 16 82 141 239 <br />Non-VFC) <br />What type of data was used to determine the provider population? (Check all the apply) <br />o Benchmarking o Medicaid Claims o Doses Administered <br />o Provider Encounter Data o Billing System Ii) Washington State Immunization Information System <br />o Other-Please Specify: