Eligibility
Program Requirements
Information Statements (IS)
Vaccine Administration
100

Children enrolled in or eligible for the state's Medicaid program belong to this eligibility category.

Medicaid-eligible children or Medi-Cal-eligible children

100

Temperatures must be documented this many times each workday.

Twice (AM & PM)

100

A VIS must be provided at this time.

before administering the vaccine

100

MMR, Varicella, and MMRV vaccines may be administered by this route/s.

subcutaneous (SQ) or intramuscular (IM)

200

This group includes children who have no health insurance coverage.

Uninsured children

200

This program provides vaccines at no cost to eligible children through age 18.

Vaccines for Children (VFC) Program

200

A VIS can be provided in these two formats.

Paper & Electronic

200

This practice is discouraged because it increases the risk of vaccine errors and waste.

Predrawing Vaccines

300

This Indigenous group primarily lives in Alaska.

Alaska Natives

300

Provider of Record for East Valley Pediatrics

Amy Kostishack, MD
300

This document explains the benefits and risks of a vaccine before it is given.

Vaccine Information Statement (VIS)

300

This must be documented before administering a vaccine and is the first question in the MAR. 

VFC eligibility

400

This Indigenous group primarily lives in the continental U.S.

American Indians

400

This occurs when vaccine storage temperatures go above or below the recommended range.

Temperature Excursion

400

The date given and this VIS-related date must be recorded in the medical record.

VIS date or VIS edition

400

If a patient receives the RSV preventive antibody Beyfortus (nirsevimab) WITH any vaccines given at the same visit and experiences an adverse event, reports should be submitted to this FDA safety reporting program.

Vaccine Adverse Event Reporting System (VAERS)

500

Children whose has insurance but does not cover vaccines.

Underinsured

500

This screening must be completed at every immunization visit.

VFC eligibility screening

500

This document explains the benefits and risks of preventive antibody injections, such as Beyfortus.

Immunization Information Statement (IIS)

500

If a patient receives the RSV preventive antibody Beyfortus (nirsevimab) WITHOUT any vaccines given at the same visit and experiences an adverse event, reports should be submitted to this FDA safety reporting program.

MedWatch

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