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2017 <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 QflQfl. 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 2 25 54 81 <br />VFC eligible-Uninsured 0 19 30 49 <br />VFC eligible-American Indian/Alaskan Native 0 0 0 0 <br />VFC eligible-underinsured at FQHC/RHC/deputized 0 0 1 1 <br />provider <br />TotaIVFC: 2 44 85 131 <br />Non-VFC Vaccine Eligibility Categories <br /># of children who received non-VFC Vaccine by Age <br />Category <br /><1 Year 1-6 Years 7-18 Years Total <br />Not VFC Eligible 0 1 9 10 <br />CHIP 0 0 0 0 <br />Private Insurance (WAA01) 0 48 58 106 <br />Other Underinsured 0 0 0 0 <br />Total Non-VFC: 0 49 67 116 <br />Total Patients (must equal sum of Total VFC + Total 2 93 152 247 <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 ~ Washington State Immunization Information System <br />o Other-Please Specify: <br />I,