VOMS Organization/Facility Client User Guide | VOMS Organization/Facility Client User Guide |
Providers can register for the Pandemic Influenza Vaccine Provider Network only after they have created an IWeb account. Therefore, non-enrolled providers need to request access to the application prior to registering to become a pandemic provider.
Providers can register for the Pandemic Vaccine Provider Network on the Provider Enrollment Application form page if the following Administration > Properties > Provider Agreement and Pandemic Agreement options are enabled by the state in IWeb in addition to the regular Provider Agreement options:
To complete the Pandemic Provider registration process, click the Pandemic Agreement link from the menu. On the Provider Agreement / Pandemic Agreement page, click Pandemic Enrollment Form toward the bottom of the page. The Online Pandemic Registration Request page opens with fields categorized in four sections:
Enter the information (click Add to add additional people to receive communications, which are then listed in the last section on the page), then click Save and Add Shipment Info to go on to the next page. The fields in the four sections on the first page are as follows:
| Field | Description |
|
Check here if the TennIIS APP is the healthcare provider who will be the lead decision maker regarding the ordering and administration of pandemic influenza vaccine |
Select this option if the TennIIS applicant is the healthcare provider that will be the lead decision maker for ordering and administration of pandemic influenza vaccines. |
|
First Name |
Enter the healthcare provider's first name. This field is required. |
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Middle Name |
Enter the healthcare provider's middle name. |
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Last Name |
Enter the healthcare provider's last name. This field is required. |
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Title |
Enter the healthcare provider's title. This field is required. |
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TN License Type |
Enter the healthcare provider's Tennessee license type. This field is required. |
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License # |
Enter the healthcare provider's license number. This field is required. |
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DOB |
Enter the healthcare provider's birthdate. This field is required. |
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|
Enter the healthcare provider's email address. This field is required. |
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Phone |
Enter the healthcare provider's phone number. This field is required. |
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Extension |
If applicable, enter the extension number for the phone number. |
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Fax |
Enter the healthcare provider's fax number. This field is required. |
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Check here if fax is the same as practice fax |
Select this option if the fax number entered above is the same fax number that the office uses. |
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Check here if the APP does not wish to receive email updates in the event of an influenza pandemic. (The pandemic point of contact will still receive email updates.) |
Select this option to only send email updates to the pandemic point of contact person instead of the healthcare provider listed in this section. |
| Field | Description |
|
Check here if the TennIIS PPOC is the person who will receive all planning and ordering instructions by email and/or fax during an influenza pandemic |
Select this option if the TennIIS primary pandemic point of contact is the person to receive planning and ordering instructions by email or fax during influenza pandemics. |
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First Name |
Enter the pandemic point of contact's first name. This field is required. |
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Middle Name |
Enter the pandemic point of contact's middle name. |
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Last Name |
Enter the pandemic point of contact's last name. This field is required. |
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Title |
Enter the pandemic point of contact's title. This field is required. |
|
|
Enter the pandemic point of contact's email address. This field is required. |
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Confirm Email |
Re-enter the email address. This field is required. |
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Phone |
Enter the pandemic point of contact's phone number. This field is required. |
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Extension |
If applicable, enter the extension number for the phone number. |
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Fax |
Enter the pandemic point of contact's fax number. This field is required. |
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Check here if fax is the same as practice fax |
Select this option if the fax number entered above is the same fax number that the office uses. |
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Preferred Method of Communication |
Select the preferred method of communication from the drop-down list: Email, Fax, or Phone |
| Field | Description |
|
First Name, Middle Name, Last Name |
Add the additional person's first name (required), middle name, and last name (required) in the provided fields. |
|
|
Enter the person's email address. This field is required. |
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Confirm Email |
Re-enter the email address. This field is required. |
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Phone |
Enter the person's phone number. This field is required. |
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Extension |
If applicable, enter the extension number for the phone number. |
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Add |
Click Add to add the person to the Persons to Receive Pandemic Communications list in the last section on the page. Add as many extra people as necessary, clicking Add after each one. |
The first part of this section lists the main people to receive communications, while the Additional Persons section lists the additional people added in the previous section. The available columns in section are as follows:
| Column | Description |
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First Name |
The first name for each extra person to receive pandemic communications. |
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Middle Name |
The middle name for each extra person to receive pandemic communications. |
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Last name |
The last name for each extra person to receive pandemic communications. |
|
Phone |
The person's phone number. |
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|
The person's email address |
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Edit |
Click the Edit icon for a person to edit their contact information. |
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Delete |
Click the Delete icon to delete an additional person in the list. |
The next page to appear after clicking the Save and Add Shipment Info button (or, for State Approver users, the View Shipment Info button) is the Pandemic Influenza Vaccine Shipment Form page. There are five categories of fields to fill out on this page:
After entering the information and selecting the options, click Save & Submit to TDH to submit the form. You can click Save & Complete Later to leave and return to the form later.
The fields and options in each section on this second page are as follows.
| Field | Description |
|
Check here if the facility shipping name and address are the same as the TennIIS practice name and address |
Select this option if the facility shipping name and address are the same as the TennIIS practice name and address. |
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Facility Shipping Name |
If the shipping address is different, enter the facility shipping name here. This field is required. |
|
Facility Shipping Street Address |
If the shipping address is different, enter the shipping street address here. This field is required. |
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BLDG/Box/Suite/Etc. |
If there is a building number, box number, suite number, etc., enter it here. |
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City |
If the shipping address is different, enter the city here. This field is required. |
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State |
If the shipping address is different, enter the state here. This field is required. |
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County |
If the shipping address is different, select a county from the drop-down list. This field is required. |
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Zip Code |
If the shipping address is different, enter the zip code here. This field is required. |
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Please select the option that best describes this practice |
Select the option that best describes the practice (this field is required):
|
| Field | Description |
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Check here if the shipping contact is the same as the primary pandemic point of contact (PPOC) |
Select this option if the shipping contact is the same as the primary pandemic point of contact (PPOC), in which case these fields do not need to be filled out. |
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First Name |
Enter the shipping contact's first name. This field is required. |
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Middle Name |
Enter the shipping contact's middle name. |
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Last Name |
Enter the shipping contact's last name. This field is required. |
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Title |
Enter the shipping contact's title. This field is required. |
|
|
Enter the shipping contact's email address. This field is required. |
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Confirm Email |
Re-enter the email address. This field is required. |
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Phone |
Enter the shipping contact's phone number. This field is required. |
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Extension |
If applicable, enter the extension number for the phone number. |
|
Fax |
Enter the shipping contact's fax number. This field is required. |
In this section, select the days that the facility is able to receive shipments, then select from the drop-down lists the time range on those days. (For example, Mondays 9:00 AM - 4:00 PM)
In this section, assuming the US can distribute enough pandemic vaccine to vaccinate every US resident within 6 months after the start of the vaccine distribution and that this vaccine is accepted by the public, enter the amounts for these questions/requests:
Select the option that best answers this question: Will you offer pandemic vaccine to the general public or will you only vaccinate current patients?
For the questions in this section, select the answer from the drop-down list or enter an amount, whichever the answer requires. The questions in this section are as follows: