Childhood Immunizations Manual
Contents
1. Lot Next Row R Alternate Date A Today s Date D Modi Field Button Description Type Type of vaccine administered Date Date vaccine administered Y N Y child received vaccine dose but date is unknown child did not and will not receive vaccine Lot Choose the Lot Clinic Choose the clinic where the child received the vaccine Nurse Choose the nurse who administered the vaccine Inj Choose the injection site Next Due Date Displays the next due date for the vaccine Print Click to open the print window Schedule S Click to display the schedule table Unknown U Click to put UNKNOWN in Lot field No N Click to put N in Y N field Lot L Click to put the default Lot in the Lot field Next Row R Click to go to the next row Alternate Date A Click to put the default alternate date in the date field Today s Date D Click to put today s date in the date field Modify Click to modify the record 20 HepB Hepatitis ka Immunization Record for SMITH JOHN 01 16 2008 OM CURRENT Find Demo Info All DTaP MMR var Pnu Rota Flu Other Adult Hepatitis Type Date Age Lot Clinic Nurse Inj 77 El J 77 M J 6 J Due Date 01 16 2008 Print Schedule S Unknown U Lot L Next Row2. Pertussis R Type Date Ag TD m BE Next Due Date 03 16 2008 Y e 15M Lot Clinic Nurse Inj Y 2 2 2 9 E B Print Schedule S Unknown U No N Lot L Next Row R Alternate Date A Today s Date D Modify Field Button Type Date Y N Lot Clinic Nurse Inj Next Due Date Print Schedule S Unknown U Lot L Next Row Alternate Date A Today s Date D Modify Description Type of vaccine administered Date vaccine administered Y child received vaccine dose but date is unknown child did not and will not receive vaccine Choose the Lot Choose the clinic where the child received the vaccine Choose the nurse who administered the vaccine Choose the injection site Displays the next due date for the vaccine Click to open the print window Click to display the schedule table Click to put UNKNOWN in Lot field Click to put N in Y N field Click to put the default Lot in the Lot field Click to go to the next row Click to put the default alternate date in the date field Click to put today s date in the date field Click to modify the record HIB Haemophilus ka Immunization Record for SMITH JOHN 01 16 2008 OM CURRENT Find Demo Info All DTaP HIB MMR Var Rota Othe
3. 0 0 0 J gu IL 1L I Delete Dr DIPHTHERIA TETANUS tT DIPHTHERIA TETANUS PERTUSSIS 1 0 Prnt FLU NLUENZA 04 feher 598 9 150 1414 HavHBP 3 040 so 150 1111414 0 0 0 0 0 2 04 9 Hee HePAmTSB 584 04 9 150 qMaeMoPHLUSHEPATTISB 1 04 jHe 1 04 je IMMUNE GLOBULIN J 1 T L MMADMN IMMUNIZATION ADMINISTRATION J J o P POLIOMYELITIS INACTIVATED J J LEAD peres ges 11414 3 wNNGoOCOCCAL 0 J 111 11 S __ WEASLES MUMPS RUBELLA of POLIOMYELITIS ORAL LIVE Field Button Description Abbreviation Enter the vaccine abbreviation Description Enter the full vaccine description Doses Enter the number of doses 15 interval Enter zero for the first interval 2 interval Enter the number of days between the 1 and 274 dose 37 interval Enter the number of days between the 2 and 3 dose 4 interval Enter the number of days between the 3 and 4 dose 5 interval Enter the number of days between the 4 and 5 dose 6 interval Enter the number of days between the 5 and 6 dose ICD9 Enter the ICD9 Code CPT Code Enter the CPT Code Amount Enter the amount of the vaccine Close Closes the table
4. 2 vaccine live oral 90712 09 30 2002 Cpt Code ee 90476 80581 04 24 2003 80585 90592 90296 90700 974 00720 2 90748 07 11 2001 90845 12 16 199 0 90655 6 30 200 90713 01 01 7200 90735 05 11 200 90733 11 15 200 07 03 2001 Print Delete Add Field Button Type Short Description Full Description Description Enter the vaccine type Enter the vaccine short description Enter the vaccine full description CDC CPT Code Enter the CPT code for the vaccine VIS Enter Vaccine Information Sheet publish date Close Closes the table Add Button Adds a row to the table Delete Button Print Button Deletes a highlighted entry Prints the list 66 Gs Zip Codes Add Button Delete Button Print Button illl Add Delete Modify Zip Code Table Close Add Delete Print Description Enter the zip code Closes the table Adds a row to the table Deletes a highlighted entry Prints the list 67 Travel Questionnaires optional module Enter Modify Questionnaires Adult QuestionnaireA Adult Questionnaire B THE INDIVIDUAL THAT IS GOING TO RECEIVE VACCINES Ill with anything more serious than a cold NO YES Have any allergies chicken eggs medications thimerosal YES Had a serious reaction to a vaccine in the past NO YES Received a transfusion of blood plasma or a medicine called immune globu
5. OK Cancel Fields that were filled out in the Default window will populate the Demographic Information window Once a client is entered a record is created that is accessible to all Community Health modules Remember you can use either the Enter key or Tab key to navigate from field to field Note All phone numbers must start with a 1 Select Parent if applicable Add Client Demographic Information Patient Name and Address Parent if applicable Insurance HIPAA Other Info Mother Guardian Last Mother Guardian First Mother Guardian Middle Mother Guardian Maiden Mother Guardian Date of Bith Mother Guardian SSN x Mother Guardian Ethnic Mother Guardian Work Phone Father s Last Name Father s First Name Father s Middle Name Father s Date of Birth Fathers SSN Enter information regarding the parents guardians Cs Insurance HIPAA _ Add Client Demographic Information Patient Name and Address Parent if applicable Other Info Primary Insurance Carrier Insurance Secondary Insurance Carrier Insurance Notice of Privacy Practice Given ft Client Parent Custodian Authorization for Release of Information Physician s Health Departments ae Family Day Care Schools Date Modified WIC xl 4 OK Enter information regarding the insurance carrier and HIPAA information Cs Other Info Add Client Demographic Info
6. 58 Recall Reminder Letters ms Enter Modify Childhood Immunization Recall Reminder Letters Recall Letter Newsletter tis very important that your child s immunizations are kept current and in the daily hustle and bustle it is all too easy to miss a booster My record shows that itis time for to receive required updated protection by the following immunizations If he she has not already received this updated protection we will be glad to provide them Please call my office for an appointment 287 9928 William Osler M D E Spell Check Close The HDIS system provides you the flexibility to write standard letters or post cards Reminder Recall and a Newsletter that can be sent to clients These letters will pull data through use of the The is placed on each end of the field name that you want to pull into the letter Use capital letters to describe the field name The letters are automatically addressed to the caregiver of the client 59 Gs Receipts Receipt Module Users Only Receipts Date Received by 712008 Print Close Fee Code Fee Description Quantity Amount Check Cash p2636 GRANT IMMUNIZATION ACTION PLAN 1 0 00 Per Lic ID Address Comment 2 7 0L LL LL Add Fee Delete Fee code Description 1 QuanjAmount Check jAddress Comment 1 11 4 4 1 Totals 0 0 00 Receipt 80007
7. Displays the next due date for the vaccine Click to open the print window Click to display the schedule table Click to put UNKNOWN in Lot field Click to put in Y N field Click to put the default Lot in the Lot field Click to go to the next row Click to put the default alternate date in the date field Click to put today s date in the date field Click to modify the record 28 Y child received vaccine dose but date is unknown Immunization Record for SMITH JOHN 01 16 2008 OM CURRENT Find Demo Info All DTaP MMR Var Pnu Rota Flu Pne Other Adult Pneumonia R Type Date Age Lot Clinic Nurse Inj Print Schedule S Unknown U No N Lot L Next Row R Alternate Date A Today s Date D Modify Field Button Description Type Type of vaccine administered Date Date vaccine administered Y N Y child received vaccine dose but date is unknown N child did not and will not receive vaccine Lot Choose the Lot Clinic Choose the clinic where the child received the vaccine Nurse Choose the nurse who administered the vaccine Inj Choose the injection site Next Due Date Displays the next due date for the vaccine Print Click to open the print window Schedule S Click to display the schedule table Unknown U Click to put UNKNOWN in Lot field No N Click to put
8. U No N Lot L Next Row R Alternate Date A Today s Date D Modify Description Type of vaccine administered Date vaccine administered child did not and will not receive vaccine Choose the Lot Choose the clinic where the child received the vaccine Choose the nurse who administered the vaccine Choose the injection site Displays the next due date for the vaccine Click to open the print window Click to display the schedule table Click to put UNKNOWN in Lot field Click to put in Y N field Click to put the default Lot in the Lot field Click to go to the next row Click to put the default alternate date in the date field Click to put today s date in the date field Click to modify the record 25 Y child received vaccine dose but date is unknown Men Meningitis Immunization Record for SMITH JOHN 01 16 2008 OM CURRENT Find Demo Info All DTaP MMR var Pnu Rota HepA Men Other Adult Type Date Meningitis R Age Lot Clinic Nurse Inj Print Schedule S Unknown U Lot Next Row R Alternate Date A Today s Date D Modify Field Button Type Date Y N Lot Clinic Nurse Inj Next Due Date Print Schedule S Unknown U No N Lot L Next Row R Alternate Date A Today s Date D Modify Description Type of vaccine administered Date va
9. 25 Men Meningitis 5 ecco 26 HPV rote 27 Flu dnil enza 28 29 30 a 31 Schedule 32 Print eis ER 33 Dig f 35 Maintenance Add Delete Modify Tables 38 Introduction This program is designed to assist you in organizing a systematic approach to entering Childhood Immunization clients and provides accurate up to date records within your county Please review the manual carefully to obtain the maximum benefits Little or no prior computer experience is necessary to operate this program About This Manual Childhood Immunizations Module is simple to use The maximum benefit with the least time spent will be obtained if you start at the first page of this manual and follow the directions exactly as you enter the first record in your computer Square boxes in this manual surround the key that you are to press on your keyboard As an example when you read press the enter key on your keyboard The word TYPE is followed
10. Add Button Adds a row to the table Delete Button Deletes a highlighted entry Print Button Prints the list 69 Travel Transfer Records to Adult Travel Immunizations optional module Transfer Records to Adult Immunizations 70 Software Inc Health District Information Systems helpdesk hdis org Software Inc Health District Information Systems helpdesk hdis org
11. Adult Travel Immunizations BCMH Childhood Immunizations Clinical Services Billing Communicable Disease Early Intervention Flu Mass Clinic Health Clinics Help Me Grow HIPAA HIVJAIDS Test Site Data Systems Home Visit Lead Clinic Making Tracks Client Nurse Employee Daily Works Sheets OIMRI Outbreak Payin Reports Receipts Tuberculosis Testing Surveillance and Control User Defined Databases Welcome Home Newborn Visits Finding Client ka Immunization Record for Find Demo Info All DTaP MMR Var Pnu Rota Flu Other Adult byID ByDate of Birth C Immunizations Only Enter Name last first middle name or ID or Date of Birth Add Name Defaults Close To find an existing client enter the name last first middle and press the Enter key The program will automatically find the name in the database If the client s name is not in the list you will then enter it in the database Radio Button Description by Name Click to find a client by name By ID Click to find a client by ID By Date of Birth Click to find a client by date of birth Immunizations Only Click to view only the immunization clients Add Name Click to add a new client Defaults Click to open the Defaults window discussed further on Close Click to exit Defaults Defaults 1 Immunization Record
12. m 4 Next Due Date 03 16 2008 Print Schedule S Unknown U No N Lot L Next Row R Alternate Date Today s Date D Modify Field Button Description Type Type of vaccine administered Date Date vaccine administered Y N Y child received vaccine dose but date is unknown N child did not and will not receive vaccine Lot Choose the Lot Clinic Choose the clinic where the child received the vaccine Nurse Choose the nurse who administered the vaccine Inj Choose the injection site Next Due Date Displays the next due date for the vaccine Print Click to open the print window Schedule S Click to display the schedule table Unknown U Click to put UNKNOWN in Lot field No N Click to put N in Y N field Lot L Click to put the default Lot in the Lot field Next Row R Click to go to the next row Alternate Date A Click to put the default alternate date in the date field Today s Date D Click to put today s date in the date field Modif Click to modify the record 19 MMR Measles Mumps Rubella Immunization Record for SMITH JOHN 01 16 2008 OM CURRENT Find Demo Info All DTaP var Pnu Rota Other Adult Measles Mumps Rubella R Type Date Age Lot Clinic Nurse Inj Next Due Date 01 16 2009 Print Schedule S Unknown U
13. 11 Immunization Record for SMITH JOHN 01 16 2008 OM CURRENT Find Demo Info DTaP MMR Var Pnu Rota Flu Other Adult ID Home Site VEC VEC Date Code General Notes Medical Notes Information Birth Information Alias Consent for Services and Release of Information M WIC Physician s SIIS Health Departments Schools Day Care Centers Third Party Payor Signature of Parent Client Signature Date Field Button ID Home Site Date General Notes Medical Notes Consent for Services and Release of Information Signature Signature Date Print Delete Immunization Record Modify Parent Guardian Print Delete Immunization Record Modify Description Number automatically assigned by the program It is a combination of birthdate last and first names Choose the home site where the child usually receives vaccines Choose the VFC code Enter the date that the VFC was signed Enter MOV for moved PCP for vaccines administered by primary care physician INA for inactive and DEC for deceased Click to enter general notes on the client Click to enter medical notes on the client Optional Fields Click the appropriate checkmark for the consent to release information Click the appropriate checkmark for the signature Ente
14. Field Button Description Type Type of vaccine administered Date Date vaccine administered Y N Y child received vaccine dose but date is unknown N child did not and will not receive vaccine Lot Choose the Lot Clinic Choose the clinic where the child received the vaccine Nurse Choose the nurse who administered the vaccine Inj Choose the injection site Next Due Date Displays the next due date for the vaccine Print Click to open the print window Schedule S Click to display the schedule table Unknown U Click to put UNKNOWN in Lot field No N Click to put in Y N field Lot L Click to put the default Lot in the Lot field Next Row R Click to go to the next row Alternate Date A Click to put the default alternate date in the date field Today s Date D Click to put today s date in the date field Modify Click to modify the record 23 Rota Immunization Record for SMITH JOHN 01 16 2008 OM 0 Weeks CURRENT Find Demo Info All DTaP MMR Var Rota Other Adult Rotavirus R Type Date Age Lot Clinic Nurse Inj RoTa J Rota 2M J ROTA J Next Due Date 01 16 2008 Print Schedule S Unknown U No N Lot L Next Row R Alternate Date Today s Date D Modify Field Button Description Type Type of va
15. Immunization Record for SMITH JOHN 01 16 2008 CURRENT Find Demo Info DTaP MMR Var Pnu Rota Other Adult Recommended Diphtheria Tetanus Acellular Pertussis i iti Varicella pae 77 2 wR 77 1 pae 77 4 m 21 Due 01 16 2009 pae 77 15 Hd F 4 Due 03 16 2008 Measles Mumps Rubella f if 11 Last Recalled Reminder MMR 7 Return Date if Due 03 16 2008 MMR Ee T ai Haemophilus Due 01 16 2009 m re 2M Hepatitis B ms 77 mes 77 m 77 mre 77 puc prs po eM ve 6 Due 03 16 2008 Due 01 16 2008 Print Modify The Mandated tab displays all mandated vaccine types dates and age they received each vaccine or the age they are due The Return Date may be set by the health department as to a specific clinic date they would like the child to return for his her next vaccine dose All ages that appear in the color red indicate that the child is due that specific dose The in the upper right hand corner is a quick way to put the letter N Y or blank in the field next to the date N indicates that dose was not given and will not be given Y indicates that the dose was given but the parent cannot remember the date Click for blank Double Click for the letter Ri
16. Prints the recall letters designed under the Maintenance menu to all children who meet the report options Prints mailing labels with the immunizations due printed on the upper right hand corner of the label Prints a list of children s names parent s names and telephone number who meet the report options Prints recall post cards designed under the Maintenance menu to all children who meet the report options Prints reminder letters designed under the Maintenance menu from the From and dates entered Prints mailing labels with the immunizations due printed on the upper right hand corner of the label Prints a list of children s names parent s names and telephone number who meet the report options Prints reminder post cards designed under the Maintenance menu to all children who meet the report options Prints out your Yearly Statistical Report when you enter a From and date Prints a report that will reveal how many children not how many injections received services in a certain time frame Prints out the records of all vaccines administered during the specified time frame with calculated statistics specify From and To dates and Clinic Site in the Report Options Prints a report that will reveal how many vaccines were administered in a certain time frame Use From date To date and Clinic Site in the Report Options Prints a list of vaccines administere
17. R Alternate Date Today s Date D Modify Field Button Description Type Type of vaccine administered Date Date vaccine administered Y N Y child received vaccine dose but date is unknown N child did not and will not receive vaccine Lot Choose the Lot Clinic Choose the clinic where the child received the vaccine Nurse Choose the nurse who administered the vaccine Inj Choose the injection site Next Due Date Displays the next due date for the vaccine Print Click to open the print window Schedule S Click to display the schedule table Unknown U Click to put UNKNOWN in Lot field No N Click to put N in Y N field Lot L Click to put the default Lot in the Lot field Next Row R Click to go to the next row Alternate Date Click to put the default alternate date in the date field Today s Date D Click to put today s date in the date field Modif Click to modify the record 21 Var Varicella Immunization Record for SMITH JOHN 01 16 2008 CURRENT Find Demo Info DTaP HIB MMR Var Pnu Rota Men HPV Flu Pne Adult Varicella R Date Age Lot Clinic Nurse Inj var jl mH vn g N LEM eo GE E Next Due Date 01 16 2009 Print Schedule S Unknown U No N Lota Next Row R Alternate Date A Today s Date D Field Button Descripti
18. by bracketed instructions of what to type into a field Note For Technical Support email helpdesk hdis org Navigation Whenever you see one A Click the left side of your mouse once Whenever you see two A click the left side of your mouse twice Navigation Keys For Entering Information or ENTER to move to next field or to go back one field places you the receipt screen Editing Keys deletes one character left of cursor Delete Pee deletes one character inserting amp overwriting modes When you see a pull down field click the arrow to the right to view all your choices Starting HDIS MICROSOFT Windows Users Start Programs Health District Info Systems HDIS Health District Information System Menu Bar Health District Information System Management Services Environmental Health Community and Public Health Services Vital Statistics Maintenance About Exit HDIS Health District Information System has several different modules designed to assist your health district in its day to day operations The Childhood Immunizations Module is a great addition to these modules and simplifies your record keeping billing and information management needs Select Community amp Public Health vd Select Childhood Immunizations Health District Information System Management Services Environmental Health 8 Vital Statistics Maintenance About Exit Appointment Books
19. default alternate date in the date field Click to put today s date in the date field Click to modify the record 30 Y child received vaccine dose but date is unknown N Adult Travel optional module Immunization Record for SMITH JOHN 01 16 2008 OM CURRENT Vaccine Type Date Lot Site Nurse Description Right click to delete a vaccine row in the grid Click to put the vaccine dates in chronological order Click to enter general notes Click to enter medical notes Click to open the print window Click to add a vaccine to the grid Used to enter next vaccine date in a series Click to modify the record 31 Schedule Button Schedule ml SCHEDULE L Bchedule Dose Vaccine Select R Recommended Schedule A Accelerated Schedule A B Accelerated Schedule B C Accelerated Schedule C N No Schedule vaccine will not be given 32 Form Print Mandated Imms with questionnaire Print Mandated Recommended Imms with questionnaire Print Mandated Recommended Imms no questionnaire Print Button Print Adult Travel Imms with questionnaire Print Adult Travel Imms no questionnaire Print Demographics amp Questionnaire C Print Adult Imms with adult questionnaire C Print Immunization Charge Slip C Print Childhood Immunization Invoice From C Print Blank Imms Form C Print Inventory Lot Numbers Outpu
20. left does not match the field on the right These two duplicate records can be combined through the two buttons Left to Right and Right to Left In this case we would click the Right to Left button because the record on the left contains more immunization dates Left to Right and Right to Left buttons will never merge a date on top of another date At times you will need to print out both left and right and research which is the correct one Remember all buttons ending with a have to be right clicked 43 Ethnic Add Delete Modify Ethnic Table Field Button Name Close Button Add Button Delete Button Print Button Description Enter ethnicity Closes the table Adds a contact to the list Deletes a highlighted entry Prints the list 44 As Export Import Receipts optional Receipt Module Users that use Remote Immunization Laptop Export Receipts This routine will export data from the receipt file The file is in the directory C HDIS EXPORT From date To date pin 712008 712008 Export Data Close Enter from and to dates of the receipts you just posted This will create a file that will be imported into the Receipts module on your server 45 As Field Names Data Base Field Names for Immunization Record Field Name DataBase FieldName 2 ALIAS FIRST NAME ALIAS LAST NAME IMM A LAST ALIAS MIDDLE NAME MIDDLE BIR
21. to find and replace physician names 54 Political Subdivisions a Add Delete Modify Political Subdivision Table code Subdivision H close Field Button Subdivision Close Button Add Button Delete Button Print Add Delete Print Description Enter the code of the subdivision Enter the subdivision Closes the table Adds a code to the table Deletes a highlighted entry Prints the list 55 Questionnaires Enter Modify Questionnaires Childhood Questionnaire A Childhood Questionnaire B Adult Questionnaire A Adult Questionnaire B Is your child sick today Has your child ever had serious reaction to a vaccine History of Guillain Barre paralysis allergic reaction to any medication food vaccine If yes specify Convulsions seizures or brain problem blood transfusion immunogloblin IG in the past year significant illness in the past 2 week Is your child taking any medication now Does your child or any family members have a weakened immune system Is your daughter possibly pregnant Does your child receive WIC services If you do not receive WIC services would you like WIC to contact you I have received a copy and have read or had read to me the information contained in the appropriate Vaccine Information Pamphlet or Important Information Statement about the disease s and vaccine s checked above I have had a chance to ask questions which were ans
22. will not receive vaccine Choose the Lot Choose the clinic where the child received the vaccine Choose the nurse who administered the vaccine Choose the injection site Displays the next due date for the vaccine Click to open the print window Click to display the schedule table Click to put UNKNOWN in Lot field Click to put N in Y N field Click to put the default Lot in the Lot field Click to go to the next row Click to put the default alternate date in the date field Click to put today s date in the date field Click to modify the record 27 Flu Influenza kJ Immunization Record for SMITH JOHN 01 16 2008 OM CURRENT Find Demo Info DTaP MMR Var Pnu Rota Hepa HPV Flu Other Adult Type Date Next Due Date 01 16 2008 Influenza R Age Lot Clinic Nurse Inj Print Schedule S Unknown U No N Next Row R Alternate Date A Today s Date D Field Button Type Date Y N Lot Clinic Nurse Inj Next Due Date Print Schedule 5 Unknown U No N Lot L Next Row R Alternate Date A Today s Date D Modify Description Type of vaccine administered Date vaccine administered child did not and will not receive vaccine Choose the Lot Choose the clinic where the child received the vaccine Choose the nurse who administered the vaccine Choose the injection site
23. Childhood Immunizations TRES E oe 5 User Childhood Immunizations Health District Information System HDIS Windows Ver 4 0 Copyright 1998 by CHC Software Inc All Rights Reserved CHC Software Inc Health District Information Systems helpdesk hdis org Table of Contents INO GU CTION Mee 1 About This iiie uie doceo e Eee iate erts 1 Navigatio E 2 Finding a LL 4 5 Entering a 7 11 14 Vaccine Shortcut Keys nnne 16 DTaP Diphtheria Tetanus and Pertussis 17 5 lt lt nere eiie 18 IP PoliomyellliS 19 MMR Measles Mumps Rubella 20 HepB Hepatitis 5 rece eere ec 21 22 Pnu Pediatric Pneumococcal Conjugate 23 ijr 24 HepA Hepatitis
24. Click to view a vaccine in the table End of Month This will calculate number of doses that should be in your inventory New Month Moves Balance at end of month to Balance at 1 of month A Vaccine Manufacturers W Add Delete Modify Vaccine Manufactures Abbreviation Abbott Laboratories includes Ross Products Division Adams Laboratories Inc Alpha Therapeutic Corporation Armour Inactive use AVB Aventis Behring L L C Inactive use ZLB Aviron Baxter Healthcare Corporation z mximimimir 362 gt Baxter Healthcare Corporation Inactive use Bayer Corporation Berna Products Corporation Berna Products Inactive use BPC B lt ioport Corporation o zE Z 7 07 Korea Green Cross Corporation la m Alc e e 65 Vaccine SIIS ml Add Delete Modify Short Description Full Description DENOVIRUS adenovirus vaccine NOS ANTHRAX gt ili SE QI Bacillus Calmette Guerin vaccine BOTULINUM ANTITIXON botulinum antitoxin dE hepatitis A vaccine JAPANESE ENCEPHALITIS meningocacal polysaccharide vaccine NF m gt 0 0 gt 2 v 2 2 5 2 4 D 0 7 2 mmR measles mumps and rubella virus vaccine 03 90707 01 15 2003 MMRV MMRV measles mumps rubella and varicella vaccine a4 94704 jop
25. If your health department has the Receipts module you have the ability to print any receipt through the Maintenance tab You may also print a receipt from the Immunization data entry windows by pressing ALT R keys 60 A Receipts In Report Receipt Module Users Only Print Pay In or Receipt From Date To Date 712008 o1 7 2008 Pay In by Receipt Book Pay in by Fund Pay in by Initials Receipt Output to Preview Print If your health department has the Receipts module you have the ability to print your pay in reports through the Maintenance tab 61 Reindex Pack Immunization Files Maintenace Reindex Pack Immunization Data Files This procedure will rebuild indexes If you have the Network Version please have all users exit HDIS This function is only needed should your data be corrupt due to a power failure Please contact CHC Software if you have any questions or concerns 62 Vaccine Intervals Immunization Intervals DTP Schedule Dose Vaccine Time Age 29 2 LR 4 ao 8 R 1 spr Next Vaccine Field Button Schedule Description Schedule for the vaccine R recommended A D Accelerated schedule N No Schedule Enter the dose Enter the vaccine type Enter the interval between doses MO Months BO Booster Age at time of dose Click to adva
26. Immunization Profile State Reports W Immunization Profile General HCFA 1500 Billing Public Clinic Name State Provider Person completing report Phone Number Field Button Description Public Clinic Name Enter the clinic name State Provider Enter the state provider number Person Completing report Enter the name of the person completing the report Phone Number Enter the phone number 51 Cs Info Codes W Add Delete Modify Childhood Immunizations Info Code Field You can make the CODE field on the INFO window tab a pull down by entering information in this table You must also activate this feature in the Immunization Profile window Field Button Name Close Button Add Button Delete Button Print Button Description Enter the code Closes the table Adds a blank row to the list Deletes a highlighted entry Prints the list 52 Gs Language af Add Delete Modify Language Table L Language Abbreviation E AMERICAN SIGN LANGUAGE ARABIC ARMENIAN Delete BENGALI CAMBODIAN KHMER Print CHAMORRO CANTONESE MANDARIN CROATIAN 0 0 L DUTCH ENouSH FARSI PERSIAN FRENCH GERMAN GREEK 000000 HINDI HMONG HUNGARIAN ILOCANO INDONESIAN Taan 44 2 i Field Button Description Language Enter the language Abbr
27. N in Y N field Lot L Click to put the default Lot in the Lot field Next Row R Click to go to the next row Alternate Date Click to put the default alternate date in the date field Today s Date D Click to put today s date in the date field Modif Click to modify the record 29 Immunization Record for SMITH JOHN 01 16 2008 Other OM CURRENT Find Demo Info All DTaP MMR Var Rota Flu Other Adult Date E Field Button Type Date Y N Lot Clinic Nurse Inj Next Due Date Print Schedule 5 Unknown U No N Lot L Next Row R Alternate Date A Today s Date D Modify Others Age Lot Clinic Nurse Inj Print Unknown U Next Row R Alternate Date A Today s Date D Description Type of vaccine administered Date vaccine administered child did not and will not receive vaccine Choose the Lot Choose the clinic where the child received the vaccine Choose the nurse who administered the vaccine Choose the injection site Displays the next due date for the vaccine Click to open the print window Click to display the schedule table Click to put UNKNOWN in Lot field Click to put N in Y N field Click to put the default Lot in the Lot field Click to go to the next row Click to put the
28. TH COUNTRY IMM BIR_COUN BIRTH ORDER IMM BIR ORDER BIRTH STATE _ IMMBIR_STATE CLIENTS SIGNATURE CLNT CODE IMM CODE DAY SCHOOL CONSENT IMM C DAY IMMBIR FAC FACILITY CODE IMM BIR FAC GUARDIAN S SIGNATURE IMM C GUAR HEALTH DEPT CONSENT _ IMM C_OHD HOME SITE LANGUAGE E LAST RECALL DATE IMM RECALL LAST UPDATE IMM LIUPD PARENT S SIGNATURE IMM C PAR PHYSICIAN CONSENT IMM C_PHYS RETURN VISIT DATE IMM RTN DATE 518 CONSENT SIS SCHOOL CONSENT IMM C_SCH 4 The field names listing can be very useful in determining what fields you wish to utilize to capture data for letters and when creating reports for that data The program will display a list of names that you can print 46 General Profile K General Profile Demographics General Management Environmental Community amp Public Health Services vita Health Department Division Address Address ze County Phone 50 Federal Tax ID Commissioner Client Gerver Location 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 Make Checks Payable to Close General Profile enables you to enter the basic information for your health department The Childhood Immunizations information can be found under th
29. ccine administered child did not and will not receive vaccine Choose the Lot Choose the clinic where the child received the vaccine Choose the nurse who administered the vaccine Choose the injection site Displays the next due date for the vaccine Click to open the print window Click to display the schedule table Click to put UNKNOWN in Lot field Click to put in Y N field Click to put the default Lot in the Lot field Click to go to the next row Click to put the default alternate date in the date field Click to put today s date in the date field Click to modify the record 26 Y child received vaccine dose but date is unknown Immunization Record for SMITH JOHN 01 16 2008 HPV OM CURRENT Find Demo Info All DTaP MMR Var Rota Men HPV Flu Other Adult Type Date Next Due Date 01 16 2017 Age HPV R Lot Clinic Nurse Inj 21 x peal 24 Print Schedule S Unknown U No N Lot L Next Row R Alternate Date A Today s Date D Modify Field Button Type Date Y N Lot 4 Clinic Nurse Inj Next Due Date Print Schedule S Unknown U No N Lot L Next Row R Alternate Date A Today s Date D Modif Description Type of vaccine administered Date vaccine administered Y child received vaccine dose but date is unknown N child did not and
30. ccine administered Date Date vaccine administered Y N Y child received vaccine dose but date is unknown N child did not and will not receive vaccine Lot Choose the Lot Clinic Choose the clinic where the child received the vaccine Nurse Choose the nurse who administered the vaccine Inj Choose the injection site Next Due Date Displays the next due date for the vaccine Print Click to open the print window Schedule S Click to display the schedule table Unknown U Click to put UNKNOWN in Lot field No N Click to put N in Y N field Lot L Click to put the default Lot in the Lot field Next Row R Click to go to the next row Alternate Date Click to put the default alternate date in the date field Today s Date D Click to put today s date in the date field Modif Click to modify the record 24 Hepatitis Immunization Record for SMITH JOHN 01 16 2008 OM CURRENT Find Demo Info All DTaP MMR Var Pnu Rota Other Adult Type Date Hepatitis A R Age Lot Clinic Nurse Inj HEPA 77 12 A 1 18 J A Next Due Date 01 16 2009 Print Schedule S Unknown U Lot Next Row R Alternate Date A Today s Date D Modi Field Button Type Date Y N Lot Clinic Nurse Inj Next Due Date Print Schedule S Unknown
31. d by child s name Prints a list of vaccines administered by vaccine type Prints a list of vaccines administered by info code Prints out the VFC field statistics 37 Maintenance Add Delete Modify Tables E Maintenance strict Information System ns Reports Browse List Export Count Graph Upload Download 10 City Clinic Sites County Duplicate Name Utility per Ethnic Export Import Receipts Teel ace ee Jb General Profile i Immunization Nurses Immunization Profile Info Codes Language Physicians Political Subdivision ins im Questionnaires Printer Setup Race Recall Reminder Letters Receipts Receipts Payin Report Reindex Pack Immunization Data Files Vaccine Intervals Vaccine Inventory Vaccine Manufacturers Vaccine Type SIIS Zip Codes Travel Questionnaire Travel Vaccine Types Travel Transfer Records to Adult Travel Immunizations The maintenance menu contains a list of tables that you can modify for your program 38 City W Add Delete Modify City Table e rim dE mi p 5 PAINESVILLE PAINESVILLE CITY 1222 FIEIS o g m lt gt Copy Master Field Button Description City Enter the city name Close Button Closes the table Add Button Adds a contact to the list Delete Button Deletes a highlighted entry Print Button Prints the list Clinic Sites ul Add Modify Delete Childhood I
32. e Community amp Public Health Services tab 47 Immunization Nurses al Add Delete Modify Nurse Employee Table Field Button Code Name District Close Button Adds Button Delete Button Print Button Description Enter a code for the nurse Enter the name of the nurse Enter the district of the nurse Closes the table Adds a nurse to the table Deletes a highlighted entry Prints the list 48 W Immunization Profile Health Department Print General Notes Print Medical Notes Immunization Profile General HCFA 1500 Billing State Reports Satellite Accept downloaded lot numbers Print Medical Notes no questionnaire Print next due date Print MFG on Questionnaire printout Use laser 3 1 2 5 postcards RecalliReminders use RETURN VISIT DATE Make Code field a pull down Registry Today s Date positions to INJ field Export MOV MOGE clients to CoCASA Check Box Health Department Print General Notes Print Medical Notes Print Medical Notes no questionnaire Print next due date Print MFG on Questionnaire printout Use laser 3 X 5 post cards Recall Reminders use RETURN VISIT DATE Make Code field a pull down Registry Today s Date positions to INJ field Export MOV MOGE clients to COCASA Description Check if you are a health department Check to have the general notes printed Check to have the medical notes printed Check to ha
33. efix or leave blank enter lot prefix for accountability report Select label size if printing mailing labels Click to preview the report Click to send the report directly to the printer Click to clear all report options Click to close the report options window Click to preview or print the report 36 Reports Reports Children s records Export to COCASA List Medicaid HCFA 1500 Billing Newsletter Physician s Patients Recall Letters Recall Mailing Labels Recall Phone List Recall Post Cards Reminders Letters Reminders Mailing Labels Reminders Phone List Reminders Post Cards Statistics Utilization Unduplicated Vaccine Accountability Vaccine Administered Vaccines by Child By Alpha Vaccines by Child By Vaccine Type Vaccines by Child By Code Vaccines for Children VFC Description Prints a list of dates and summarizes the status of each procedure for the individual child A one page report for each child that meets the selected options will be printed Report will export a text file that can be imported into CASA Refer to Uploading to CASA manual to complete this task Prints a list of all children meeting the report options Prints out HCFA 1500 in batch use From and vaccine dates Prints out the newsletter in batch for the children that meet the selected report options Prints a patient report for each physician for their office
34. eviation Enter the language abbreviation Close Button Closes the table Add Button Adds a contact to the list Delete Button Deletes a highlighted entry Print Button Prints the list 53 Physicians Add Delete Modify Physicians Name 1 E ABDULLAH ABELSON Delete ABUS SHAWEESH MD JALAL M AHUJA M Find amp Replace gt gt 83 AKAZAR mh he ee en e Ee gt gt P 14 gt e gt gt lt m 2 2 gt ANDERSON MD MICHAEL gt gt DR SA ANDREW DR ANDREWS ANNABLE MD WILLIAM L ANNAI 4 Field Button Description Name Enter the name of the physician Address1 Enter the address of the physician Address2 Enter the address of the physician City Enter the city of the physician State Enter the state of the physician Zip Enter the zip of the physician Provider Enter the provider of the physician Phone Enter the phone number of the physician Fax Enter the fax number of the physician Group Name Enter the group name of the physician Type of Practice Enter the type of practice Close Button Closes the table Add Button Adds a physician to the table Close Button Closes the table Delete Button Deletes a highlighted entry Print Button Prints the list Envelope Closes the table Find amp Replace Click
35. for Defaults Adult Travel Immunization Defaults Alternate Date if Met MMR o E Sex Race MMRY if zn E Physician z City State EN Zip gs SES County Tdap Phone VAI a i Site ac lt Nurse lt Injection Site Print Close VFC Date default information will automatically input the information you choose for each client To select default information click on the appropriate button In this example we will click on the Flu button Flu Defaults Li Immunization Record for Defaults Add Modify Delete Tables fee 2 Altemate Date 8 o 0 1 zy 2 3 Race Physician ity State rd Zip County _ Eu Ee Phone Site VFC Date Select Delete i The flu lot inventory table will appear where you are able to choose the default lot number Entering a Client Select Add Name W Add Client Demographic Information Patient Name and Address Parent if applicable Insurance HIPAA Other Info Last Name First Name Middle Name Suffix Date of Bith as of Today Sex Race Social Security amp w L2 Street amp Street Street Suffix Apt amp City State Zip Code County Y Political Subdivision Phone Y a ur es Primary Care Physician Census
36. ght Click for the letter Y 14 Recommended Immunization Record for SMITH JOHN 01 16 2008 OM CURRENT Find Info DTaP MMR Var Pnu Rota Flu Other Adult Mandated Pediatric Pneumococcal Conjugate Meningococcal Pneumonia men ve 10 me HI Due 01 16 2008 Due HPV Other pov 77 Due 03 16 2008 7 Rotavirus By Due 01 16 2017 ROTA 2 Rom 77 Influenza Due 01 16 2008 Fu elated FLU i 1M Due 01 16 2008 hera 18 Due 01 16 2009 The Recommended tab displays all recommended vaccine types dates and age client has received each vaccine or the age they are due 15 The shortcut keys listed below will assist you in entering all your vaccines CTRL A CTRL V CTRL E CTRL L CTRL M CTRL R CTRL N CTRL P CTRL S CTRL D CTRL U Vaccine Shortcut Keys Alternate Date Copy DTAP Dates Erases a row Lot Only Move Date Next Row NO Print Immunization Schedule Today s Date Unknown DTaP Diphtheria Tetanus and Pertussis Immunization Record for SMITH JOHN Find Demo Info DTaP 01 16 2008 OM CURRENT MMR Var Pnu Rota Flu Other Adult Diphtheria Tetanus
37. lin in the past year NO YES Had a seizure or neurological problem NO YES Currently nursing a baby NO YES Reside in a home with a newborn infant NO YES DOES THE INDIVIDUAL AND OR ANYONE LIVING WITH OR TAKING CARE OF THE INDIVIDUAL Have cancer leukemia AIDS or any other immune system problem NO YES Taken cortisone prednisone other steroids anticancer drugs or x ray treatments in the past three months NO YES Pregnant or at risk of becoming pregnant within the next three months NO YES I have answered the above questions to the best of my knowledge I have received copy of the IIS statements about the disease s for which vaccine s are being given today I understand the benefits amp risks of the vaccine s amp give my consent that the vaccine s indicated on this form be given to me or the person named for whom I am authorized to make this request I grant permission thia reenrd he released the Folloawines ihram line thrnaneh nlaecee vanr Spell Check Close The Immunization module allows you to develop your own adult travel questionnaires to the program These questionnaires can be printed from the Print button 68 Travel Vaccine optional module E Add Modify Delete Types of Adult Vaccines Abbreviation Description vss stinterval 2nd intervall3rd interval 4th interval re 40 L J j J Jp pH X pex
38. mmunization Clinic Sites Code Send to Clinic Name Provider Person Completing Report Field Button Code Send to ODH Clinic Name ODH Provider Person Completing Report Phone Medical License Medicaid Tax ID Close Button Add Button Delete Button Print Button Description Enter the clinic code Enter a Y for yes or an N for no Enter the clinic name Enter the Provider Enter the name of the person completing the report Enter the clinic phone number Enter the clinic Medical License optional Enter the Medicaid optional Enter the tax ID number optional Closes the table Adds a contact to the list Deletes a highlighted entry Prints the list 40 County W Add Delete Modify County Table Field Button County Close Button Add Button Delete Button Print Button Description Enter the county name Closes the table Adds a contact to the list Deletes a highlighted entry Prints the list 41 ci Duplicate Name Utility Duplicate Name Utility ET m DOB Sex Street Street City Zip City Zip Phone SSH Phone SSH Guar Guar GSSN i Updated GSSH i Updated DTaP DTaP HIB PV Leftto Right Delete Left Print Left Search Print Right Delete Right Rightto Left The Duplicate Name Utility allows you to locate clients in the immunization program that have been accidentally added more than once To sea
39. nce to next vaccine Closes the table 63 ot 8 of month Bal end of month In from stat 5 1 1 7 1 114 1 j ES T J T T 514 1 E o opo 12 New Month Field Button Description Type Choose the vaccine type Lot Enter the lot preface all lot numbers with the first initial of the health department county or city Mfg Choose the vaccine manufacturer VIS Enter the VIS date mm dd yy format Bal 1 of month After you have finished your end of the month reports right click New Month button to populate this field Bal end of month Enter after taking a physical inventory the last day of the month In from State Enter number of doses received from ODH Date Received Enter the date vaccine was received Exp Date Enter the vaccine expiration date Purchased Enter the number of doses purchased Expired Enter of doses that have expired Wasted Enter of doses wasted National Vaccine Abbr Enter the national vaccine abbreviation discontinued CPT Code Enter the CPT Code Charge Enter the charge for the vaccine 64 Adult Current Adult Vaccine Adult Purchased Close Click to close the vaccine inventory table Add Click to add a vaccine Delete Click to delete a vaccine Print Click to print a list of the vaccines Zoom
40. nization with the questionnaire Adult Travel Module only Prints an adult s travel immunization without the questionnaire Adult Travel Module only Prints adult travel immunization invoice for the client that falls between the From and To date range Adult Travel Module only Prints immunization charge slip Adult Travel Module only Prints Questionnaire A Prints Questionnaire B another language Prints the report Previews the report 34 Reports Reports Childhood Immunizations Health District Information System Immunizations 86 Browse List Export Count Graph Upload Download Maintenance Return Children s Records Export to CoCasa List Medicaid HCFA 1500 Billing Newsletter Physician s Patients Recall Reminders Statistics Utilization Unduplicated Vaccine Accountability Vaccine Administered Vaccines by Child Vaccines For Children VFC List Report Options From Age Sex City State Zip County Y Ethnic Code 5 Insurance 22141 Output to Clear Options Close Status 3s Vaccine Type From Vaccine Date Vaccine Date Lm Lot Number 1 Nurse Clinic Lot Prefix Label Post Cards s vj C Printer OK Preview When you choose a report the Report Options window abo
41. on Type Type of vaccine administered Date Date vaccine administered Y N Y child received vaccine dose but date is unknown N child did not and will not receive vaccine Lot Choose the Lot Clinic Choose the clinic where the child received the vaccine Nurse Choose the nurse who administered the vaccine Inj Choose the injection site Next Due Date Displays the next due date for the vaccine Print Click to open the print window Schedule S Click to display the schedule table Unknown U Click to put UNKNOWN in Lot field No N Click to put N in Y N field Lot L Click to put the default Lot in the Lot field Next Row R Click to go to the next row Alternate Date A Click to put the default alternate date in the date field Today s Date D Click to put today s date in the date field Modify Click to modify the record 22 Pnu Pediatric Pheumococcal Conjugate Immunization Record for SMITH JOHN 01 16 2008 OM CURRENT Find Info All DTaP MMR Pnu Rota Flu Other Adult Pediatric Pneumococcal Conjugate R Type Date Age Lot Clinic Nurse Inj 77 E Posi I sx kg Pos s d E Hi 8 Y Pru 17 12 Next Due Date 03 16 2008 Print Schedule S Unknown U No N Next Row R Alternate Date A Today s Date D
42. r Adult Haemophilus R Type Date Age Lot Clinic Nurse Inj HB 2 i HIB Next Due Date 03 16 2008 Print Schedule S Unknown U No N Lot L Next Row R Alternate Date Today s Date D Modify Field Button Description Type Type of vaccine administered Date Date vaccine administered Y N Y child received vaccine dose but date is unknown N child did not and will not receive vaccine Lot Choose the Lot Clinic Choose the clinic where the child received the vaccine Nurse Choose the nurse who administered the vaccine Inj Choose the injection site Next Due Date Displays the next due date for the vaccine Print Click to open the print window Schedule S Click to display the schedule table Unknown U Click to put UNKNOWN in Lot field No Click to put in Y N field Lot L Click to put the default Lot in the Lot field Next Row R Click to go to the next row Alternate Date Click to put the default alternate date in the date field Today s Date D Click to put today s date in the date field Modif Click to modify the record 18 Poliomyelitis ka Immunization Record for SMITH JOHN 01 16 2008 OM CURRENT Find Demo Info All DTaP MMR Var Rota Other Adult Poliomyelitis R Type Date Age Clinic Nurse Inj
43. r the signature date Click to open the print window Click to delete the immunization record Click to modify a record 12 Birth Information Alias ka Immunization Record for SMITH JOHN 01 16 2008 OM CURRENT Find Demo Info DTaP MMR Var Pnu Rota Flu Other Adult General Notes Home Site VEC Date 1608SMIJO 11 Information Birth Facility Name and Code Patient Birth State Alias Last Name Patient Birth Country Medical Notes State File Birth Order Language Alias First Name Alias Middle Name Print Delete Immunization Record This tab allows you to enter the birth and alias information on the client optional Field Button Birth Facility and Code State File Birth Order Patient Birth State Patient Birth Country Language Alias Last Name Alias First Name Alias Middle Name Print Delete Immunization Record Modify Description Choose the birth facility Enter the state file Enter the client s birth order Choose the client s birth state Choose the client s birth country Choose the client s language Enter the client s alias last name Enter the client s alias first name Enter the client s alias middle name Click to open the print window Click to delete the immunization record Click to modify the record 13 All
44. rch for duplicate names type the last name in the Name field or leave blank and click the Search button 42 ul Duplicate Name Utility _ sox Street SaaS City Zip Phone 5518 Guar 6558 DTaP ff il M Site GCCBK Updated 01 22 2008 ii HIB PV MMR PHU 01 22 2008 HepA HPV Rota FLU Other if fi c9 Ee OSs N e 31 a Cos UB F 1 dj iii Left to Right Delete Left Print Left mame we or2208smio1 Sex Street E Ss City Zip 1 aa Updated o Guar GSSH DTaP HIB HepB PHU VAR HepA HPV Rota FLU Other ces 223 a ii i Print Right Delete Right Rightto Left This utility determines a duplicate by an exact match of last name an exact match of Sex an exact match of birthdate and an exact match of the first initial of the first name In the example above the utility found two records with the same name of John Smith Green indicates that the field on the left matches the field on the right Red indicates the field on the
45. rmation Patient Name and Address Parent if applicable Insurance HIPAA Other Info Alternate Mailing Address City State Zip Code Household size Gross Income Verified Revised 0 Week Month Year By week if if Sliding Fee A 100 Calc Sliding Fee No Statement Match Consent When you are finished entering the client s demographic data click the OK button to move onto the Info tab of the Childhood Immunizations windows 10 Info Tab cA Info Tab Immunization Record for Find Demo DTaP MMR Var Pnu Rota Other Adult IDE Home Site VEC Date Code prs up 4 Information Birth Information Alias Medical Notes Consent for Services and Release of Information WIC Schools SIIS Physician s Day Care Centers Health Departments Third Party Payor Signature of Parent Client Parent Guardian Signature Date WEM Add Immunization Record ea When you are entering a client for the first time you will have to give them a Childhood Immunizations record To do this simply click the Add Childhood Immunizations Record button This will allow you to begin filling out all of the information Note You only have to add an immunization record once Once a record has been created you do not have to add it again
46. t to Print C Preview OK otemoos ot 6 2008 Questionnnaire CB Print The print button is available on all the window tabs The print menu is the same and you may print any of the options no matter what tab you have open at the time Field Button Mandated Imms with questionnaire Mandated Recommended Imms with questionnaire Mandated Recommended Imms no questionnaire Demographics amp Questionnaire Adult Imms with adult questionnaire Childhood Immunization Invoice HCFA 1500 Description Prints a child s record with mandated immunizations with the questionnaire Prints a child s record with mandated and recommended immunizations with the questionnaire Prints a child s record with mandated and recommended immunizations without the questionnaire Prints child s demographic information along with the questionnaire Prints adult immunizations with questionnaire Prints immunization invoice from the From and date range tange Prints HCFA 1550 from the From and To date range 33 Blank Imms Form Inventory Lot Numbers Adult Travel Imms with questionnaire Adult Travel Imms no questionnaire Adult Travel Immunization Invoice Immunization Charge Slip Questionnaire A Questionnaire B Print Preview Prints blank immunization form Prints vaccine inventory with lot numbers Prints an adult s travel immu
47. ve appears enabling you to set filters on your reports The next page explains the options 35 Report Options Report Options From Age To Age Sex City State Zip County Ethnic Race Physician Code Home Site Insurance Status Vaccine Type From Vaccine Date To Vaccine Date Lot Number Nurse Clinic Lot Prefix Label Post Cards Preview Printer Clear Options Close OK Description Enter the from age range equal to or greater than child age Enter the to age range equal to or less than child age Select a particular gender or leave blank Select a particular city or leave blank Select a particular state or leave blank Select a particular zip code or leave blank Select a particular county or leave blank Select a particular ethnicity or leave blank Select a particular race or leave blank Select a particular physician or leave blank Select a particular code or leave blank Select a particular home site or leave blank Select a particular VFC code or leave blank Select a particular insurance or leave blank Select a particular status or leave blank Current or Not Current Select a particular vaccine type or leave blank Enter the immunization date equal to or greater than Enter the immunization date equal to or less than Enter lot number for a specific report optional Select a particular nurse or leave blank Select a particular clinic or leave blank Select a particular lot pr
48. ve the medical notes printed without the questionnaire Check to have the next due date printed Check to have the manufacturer printed on the questionnaire Check if you use 37 gt X 5 postcards Check to use the Return Visit Date for the recall reminder letters instead of calculated date Check to make the code field a pull down menu Check if this PC is or has access to the registry Check to automatically have today s date entered in the INJ field Check if you want your MOGE to be exported to 49 Satellite Check if this PC is a satellite to the registry Accept downloaded lot s Check to download all lot numbers to the laptop Immunization Profile HCFA 1500 Billing Immunization Profile General State Reports Charge for office visit Office visit amount Charge for vaccine Vaccine Amount Amount Medicaid Others ICD9 Code Medicaid 33a Box 31 Field Button Description Charge for office visit Check if you charge for an office visit Office visit amount Enter the charge for the office visit Charge for vaccine Check if you charge for a vaccine Vaccine Amount Enter the vaccine amount TB Amount Enter cost of TB test ICD9 Code Enter the ICD9 code V06 8 Medicaid 33a DISCONTINUED Box 31 DISCONTINUED Casesource ICD9 Code DISCONTINUED Casesource 33a DISCONTINUED Qualchoice ICD9 Code DISCONTINUED Qualchoice 33a DISCONTINUED 50
49. wered to my satisfaction I believe I nnn deretannd the henefita and riaka nf the warerinels and aak that the Spell Check Close The Immunization module allows you to develop your own child and adult questionnaires to the program These questionnaires can be printed out from the Print button Questionnaire may be used for another language 56 Print Setup Print Setup Printer Name Auto HP LaserJet 4050 Series PELE on Properties Status Ready Type HP LaserJet 4050 Series PCL6 Where OPTIPLEX 745 HPLaser Comment Paper Size Letter Portrait Source Automatically Select Landscape Orientation Network OK Cancel The print setup allows you to choose what printer you would like to print from Pick the printer in the name dropdown and click OK 57 Cs Race Table W Add Delete Modify Race Table 0 22 2 Tin Field Button Name Close Button Add Button Delete Button Print Button 3 AMERICANINDIAN ORALASKAN ASIAN ORPACIFICIBLANDER LACK OR AFRICAN AMERICAN FEMALE 20 FDSFSD GGHDFFGHFG ISPANIC MORE THAN ONE RACE REPORTED gt TIZA I SJAJI p m 2 m mm OJD Description Enter the name of the race classification Closes the table Adds a race classification to the table Deletes a highlighted entry Prints the list
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