201 W Preston Street, Baltimore, MD 21201

Maryland Vaccines for Children Program

ImmuNet Manual Data Entry Provider Agreement

ImmuNet Manual Data Entry Provider Agreement

 

  • As stated in the Maryland Vaccines for Children (VFC) Program Online Enrollment Agreement #15: “I will report to the Maryland Immunization Information System (ImmuNet) all doses of vaccines administered to children less than 19 years of age within seven (7) calendar days of vaccine administration.” The undersigned agrees to comply with this agreement by conducting manual data entry of all doses administered to ImmuNet within seven (7) days of vaccine administration. The undersigned signs this agreement on behalf of all vaccine providers, clinical practitioners, nurses, and others associated with the healthcare facility associated with the VFC PIN. The undersigned acknowledges that failure to report this data may result in suspension and/or termination from the Maryland VFC Program. This agreement will be terminated upon the successful connection of an Electronic Health Record (EHR) / Electronic Medical Record (EMR) to ImmuNet.
  • Clear Signature
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