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Hepatitis Vaccine Distribution Program: Application Due January 20, 2017

Thanks to the dedication of and approval from the SF Health Commission, each year, the San Francisco Department of Public Health is able to provide a number of eligible, non-profit health care organizations with limited amounts of Hepatitis A and B vaccine to be administered to San Francisco residents who may otherwise be unable to afford vaccination. Hepatitis vaccine made available through this program should be used only for low-income uninsured and underinsured adults in San Francisco. For more information on eligibility, please review the program guidelines. For additional information on dosing and populations recommended to receive hepatitis vaccine, review the CDC pediatric and adult vaccine schedules.

 

Open enrollment for the Hepatitis vaccine program is limited to once per year. Occasionally, special circumstances may allow for entry into the program outside of the normal open enrollment period. Participating providers must commit to accurate and timely documentation and reporting of vaccine usage, serving patients who are eligible for free or low-cost health care services, and fulfilling vaccine storage and handling requirements. Vaccines need to be stored at the right temperature (35 to 46°F) to protect your patients from disease. Adhering to vaccine storage and handling protocol is critical to the success and effectiveness of your vaccination efforts. Continuation of the program depends on availability of vaccine.

 

Hepatitis Application Components: due Friday, January 20, 2017

Please note: If you are also applying to the 2017 Tdap program, you only need to submit items #3 to #4 once.

  1. Application form
  2. Usage agreement
  3. Key Staff Contacts Form
  4. Completed Checklist for Safe Vaccine Storage and Handling

     

    Returning applicants: have you had any staff changes since the last time you submitted an application to any SFDPH Immunization Program? If so, please have all new Vaccine Coordinators, new Back-Up Coordinators and any other new staff responsible for temperature monitoring take two online trainings: 1) "Storing Vaccines" and 2) "Monitoring Storage Unit Temperatures," both available at eziz.org/eziz-training.*

     

    New applicants: Please have your Vaccine Coordinator, Back-Up Coordinators and any other staff responsible for temperature monitoring take two online trainings: 1) "Storing Vaccines" and 2) "Monitoring Storage Unit Temperatures," both available at eziz.org/eziz-training.* You may be asked to submit additional documents with your application, such as a temperature log for your vaccine storage unit. Contact tina.milton@sfdph.org or debra.berliner@sfdph.org for more information.

     

Usage Report Due Dates

 

Additional Resources:

Hepatitis A and B Vaccine Information Statements

Adult Vaccine Request Form - to be submitted by current program members when vaccine is needed througout the year

Hepatitis Vaccine Authorization Record Forms 2017

Ad-Hoc Vaccine Request Form - organizations looking to request any vaccine (including hepatitis) for a health fair or limited-time event, should complete this form and submit via fax to (415) 554-2579

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