In an effort to prevent cancer, the New Hampshire Comprehensive Cancer Collaboration (NH CCC) has dedicated funding to support providers who are interested in improving adolescent immunization rates, specifically HPV. Funds can be used to support staff time to plan, implement and evaluate HPV improvement projects.

The following survey is an application for a $2,500 stipend to clinics interested in improving their HPV vaccination rates through implementing evidence-based strategies including use of standing order, reminder/recall systems, provider prompts and use of strong provider recommendations.

* 1. Contact Information:

* 2. The following questions relate to the current strategies you are using to improve HPV vaccination rates:

  Yes No Unsure
Provider prompts for HPV vaccination (e.g., a flag in the chart, etc.)?
Standing order for HPV vaccination for all children 11 to 13 years-old?
HPV reminder project (e.g., post-cards, phone calls, etc.)
HPV recall project (e.g., calls when people are due for next series)

* 3. The following questions relate to your plans to improve HPV vaccination rates within your clinic:

  Yes No Unsure
Develop a system for provider prompts related to HPV vaccination.
Develop a reminder system for families when a child is due for vaccination.
Develop a recall system for families when a child is due for follow-up HPV vaccination.
Develop a system to ensure standing orders for any child between 11-13 for HPV vaccination.

* 4. The following questions relate to your current capacity to look at HPV immunization rates in your clinic:

  No Yes, for the entire clinic Yes, for the entire clinic and by provider Unsure
Are you able to determine the percentage of females and males 13 years of age who have initiated the HPV vaccine series?
Are you able to determine the percentage of females and males 13 years of age who have completed the HPV vaccine series?

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