Reporting Vaccines Administered

In order to comply with CDC 2009 H1N1 vaccination program requirements, and to assure that the Maryland vaccination program is effectively meeting the vaccine needs of target groups and others, providers receiving 2009 H1N1 vaccine have agreed to provide DHMH with information about vaccine doses administered. Users of ImmuNet, the state immunization registry, can comply with this requirement by normal reporting through ImmuNet. Other providers can comply with this requirement through use of a DHMH scan form. For some special situations (e.g., large-scale school vaccination programs; large health care organizations able to provide pre-approved electronic files), other reporting mechanisms might be accepted. For more details about reporting, click on the appropriate link below:

ImmuNet

For those enrolled in the ImmuNet Immunization Registry, please go to the ImmuNet homepage for instructions on using the system for your H1N1 vaccine reporting: www.mdimmunet.org

• 2009 H1N1 Guidance for Current ImmuNet Users

For reference, please see the following ImmuNet screens that will be utilized for reporting the required H1N1 data:

• Patient View/Add
• Vaccinations View/Add

For providers who would like to enroll in ImmuNet, you will need to complete the following four forms:

• Provider Site Enrollment Form
• Additional Site Enrollment Form
• Individual User and Confidentiality Agreement Form
• Password Request Form

DHMH Scan Form

Below is a copy of the DHMH scan form as an example for planning and other purposes. Providers MAY NOT submit copies of this form printed from this site, since such copies will not scan adequately. These copies are posted here for planning and illustrative purposes only. Packets of actual scannable copies, in both English and Spanish, will be sent to providers as they order vaccine.

• Scan Form (English Version)
• Provider guidance for use of the 2009-2010 H1N1 INFLUENZA VACCINATION CONSENT AND ADMINISTRATION RECORD
• Scan Form (Spanish Version)

Special Situations

Schools

• H1N1 LAIV Consent Form
• H1N1 LAIV Consent Form (Spanish)


• H1N1 Injectable Consent Form
• H1N1 Injectable Consent Form (Spanish)


• Guidance for LAIV Consent Form
• Guidance for Injectable Consent Form

Large Healthcare Organizations

• Electronic Reporting