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Provider Agreement Immunization Program (2)
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2018-06-05 10:00 AM - Commissioners' Agenda
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Provider Agreement Immunization Program (2)
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Last modified
6/13/2018 12:43:55 PM
Creation date
6/13/2018 12:43:21 PM
Metadata
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Template:
Meeting
Date
6/5/2018
Meeting title
Commissioners' Agenda
Location
Commissioners' Auditorium
Address
205 West 5th Room 109 - Ellensburg
Meeting type
Regular
Meeting document type
Fully Executed Version
Supplemental fields
Alpha Order
l
Item
Request to Approve a Provider Agreement for the Washington State Department of Health Immunization Program
Order
12
Placement
Consent Agenda
Row ID
45299
Type
Agreement
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2018 <br />WASHINGTON STATE DEPARTMENT OF HEALTH <br />OFFICE OF IMMUNIZATION AND CHILD PROFILE <br />Organization Name: KITTITA S COUNTY HEALTH DEPARTMENT <br />Clinic/Facility Name: KITTITAS COUNTY HEALTH DEPARTMENT <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 Ellgibility Categories <br /># of children who received VFC Vaccine by Age Category <br /><1 Year 1-6Years 7-18Years Total <br />VFC eligible-Medicaid/Medicaid Managed Care 2 24 39 65 <br />VFC eligible-Uninsured 0 11 15 26 <br />VFC eligible-American Indian/Alaskan Native 0 0 0 0 <br />VFC eligible-underinsured at FQHC/RHC/ 0 0 3 3 <br />deputized provider <br />TotalVFC: 2 35 57 94 <br />Non-VFC Vaccine Eligibility Categories <br /># of children who received non-VFC Vaccine by Age Category <br /><1 Year 1-6Years 7-18Years Total <br />Not VFC Eligible 0 3 9 12 <br />CHIP 0 0 0 0 <br />Private Insurance (WM01) 1 37 43 81 <br />Other Underinsured 0 0 0 0 <br />Total Non-VFC: 1 40 52 93 <br />Total Patients (must equal sum of Total VFC + Total 3 75 109 187 <br />Non-VFC) <br />What type of data was used to determine the provider population? (Check all the apply) <br />• Benchmarking • Medicaid Claims D Doses Administered <br />O Provider Encounter Data <br />• Other-Please Specify : <br />• Billing System 151 Washington State Immunization Information System
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