Become a Provider
Each vaccination site within an organization must enroll in ImmPRINT and complete the COVID-19 Provider Agreement and Profile to participate in the program.
Complete COVID-19 Provider Agreement and Profile
If you are already enrolled in ImmPRINT, the Provider Agreement and Profile MUST still be completed. Utilize and follow the instructional video(s): “Initial Site Enrollment” and “COVID-19 Special Project Enrollment”
COVID-19 Provider Agreement Requirements Summary
- Administer vaccine in accordance with all CDC requirements and CDC’s Advisory Committee on Immunization Practices (ACIP)
- Enter all COVID-19 vaccine administered doses required data elements within 24 hours into ImmPRINT. Please include the patient’s email for second dose reminder
- Preserve administration records for a minimum of 3 years
- Do not sell or seek reimbursement for COVID-19 vaccine and any adjuvant, syringes, needles, or other constituent products and ancillary supplies provided by federal government
- Administer COVID-19 vaccine regardless of the vaccine recipient’s ability to pay COVID-19 vaccine administration fees
- Provide EUA fact sheet or Vaccine Information Statement (VIS) before administering COVID-19 vaccine
- Conduct COVID-19 vaccination services in compliance with CDC’s Guidance, including https://vaccinefinder.org/ daily inventory, for Immunization Services During the COVID-19 Pandemic for safe delivery of vaccines.
- Comply with CDC requirements for COVID-19 vaccine management
- Store an handle COVID-19 vaccines properly, maintain cold chain conditions, and chain of custody at all times
- Monitor vaccine-storage-unit temperatures at all times. ADPH will provide when available for ultra-cold vaccine
- Comply with AL’s Immunization Division guidance for temperature excursions supplied by IMM field staff
- Monitor and comply with COVID-19 vaccine expiration dates
- Report the number of doses of COVID-19 vaccine and adjuvants that were unused, spoiled, expired, or wasted in ImmPRINT when available.
- Comply with all federal instructions and timelines for disposing COVID-19 vaccine and adjuvant when available
- Report moderate and severe adverse events following vaccination to the Vaccine Adverse Event Reporting System (VAERS), https://vaers.hhs.gov/esub/index.jsp.
- Provide a completed COVID-19 vaccination record card to every COVID-19 vaccine recipient as a reminder for second dose if applicable
Utilize and follow the instructional video titled Vaccine Ordering Management System on the ADPH website (link below)
- Link to the ImmPRINT roadmap: https://www.alabamapublichealth.gov/immunization/assets/immprint_registration_roadmap.pdf
- COVID-19 Vaccine Expiration Date Tracking Tool: https://www.alabamapublichealth.gov/immunization/assets/covid19_pfizervaccine_expiration_tracking.pdf
- View the CDC video “COVID-19 Vaccine Training Module- General Overview of Immunization Best Practices for Healthcare Providers” https://www2.cdc.gov/vaccines/ed/covid19/
- View the ADPH Video “ Ordering COVID-19 Vaccine” https://youtu.be/IJ2FgLcAtF4
- Administrative cost for vaccine for the uninsured will be covered by HRSA – https://www.hrsa.gov/CovidUninsuredClaim and FAQs for COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing, Treatment and Vaccine Administration | Official web site of the U.S. Health Resources & Services Administration (hrsa.gov)