1. NJAAP Survey to Gather Information from VFC Providers

Over the last 6-9 months, we have been made aware of an alarming rise in the number of instances where practices have been placed on vaccine hold or quarantined by VFC due to noncompliance. The purpose of this survey is to get a better understanding of the scope of the issue. Please complete and return this copy or visit https://www.surveymonkey.com/r/ML8MYRN to submit online. Thank you.
 
05/23/18

Our Practice has been a VFC Provider helping to immunize children for:

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* 1. Our Practice has been a VFC Provider helping to immunize children for:

Please provide the following details.

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* 2. Please provide the following details.

Has your practice ever experienced a quarantine resulting from a temperature excursion?

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* 3. Has your practice ever experienced a quarantine resulting from a temperature excursion?

Has your practice ever experienced a vaccine hold resulting from a temperature excursion?

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* 4. Has your practice ever experienced a vaccine hold resulting from a temperature excursion?

If yes, when was the most recent occurrence?

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* 5. If yes, when was the most recent occurrence?

How many times has your practice been found to be out of compliance with storage and handling requirements?

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* 6. How many times has your practice been found to be out of compliance with storage and handling requirements?

Did the quarantine(s) occur during an epidemic, e.g. flu season or an outbreak?

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* 7. Did the quarantine(s) occur during an epidemic, e.g. flu season or an outbreak?

Has your practice ever considered dropping out of the VFC program as a result of your experience?

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* 8. Has your practice ever considered dropping out of the VFC program as a result of your experience?

The most recent temperature excursion was a result of:

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* 9. The most recent temperature excursion was a result of:

How was the excursion discovered/reported?

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* 10. How was the excursion discovered/reported?

If self-reported, how quickly did you reach out and report incident to VFC?

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* 11. If self-reported, how quickly did you reach out and report incident to VFC?

How soon after reporting excursion to VFC did you contact the manufacturer(s) to assess viability?

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* 12. How soon after reporting excursion to VFC did you contact the manufacturer(s) to assess viability?

How soon after providing manufacturer-supplied vaccine viability information did VFC respond?

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* 13. How soon after providing manufacturer-supplied vaccine viability information did VFC respond?

How would you rate your total experience with VFC throughout this process?

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* 14. How would you rate your total experience with VFC throughout this process?

Was a penalty assessed

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* 15. Was a penalty assessed

What was the required time frame for penalty repayment

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* 16. What was the required time frame for penalty repayment

What was your approximate monetary penalty?

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* 17. What was your approximate monetary penalty?

From excursion discovery through resolution, approximately how many patients missed scheduled vaccinations?

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* 18. From excursion discovery through resolution, approximately how many patients missed scheduled vaccinations?

How long did the entire resolution process (including quarantine) last?

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* 19. How long did the entire resolution process (including quarantine) last?

Which of the following best describes your practice setting?

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* 20. Which of the following best describes your practice setting?

To receive a copy of the aggregate survey results/summary, provide your name and contact information:

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* 21. To receive a copy of the aggregate survey results/summary, provide your name and contact information:

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