State Licensed Only Facility Vaccine Data 

The Department of Health and Senior Services is planning for the upcoming approval of booster COVID-19 vaccination doses and long term care facilities will be a priority. The federal pharmacy program used to administer first and second doses will not be available, so it is important to ensure long term care facilities receive the needed support for the administration of booster doses. We are asking for your feedback regarding your facility’s readiness to administer booster doses. Please reply by September 15, 2021.  

For those SNFs (Medicaid/ Medicare certified) that already completed the NHSN survey, we already have your results no further action is needed. 

For questions regarding this survey, please contact Lana Hudanick at Lana.hudanick@heatlh.mo.gov or 314-982-8260.  

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* 1. Full Name of Facility

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* 2. Level of Care

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* 3. County where facility is located

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* 4. Current number of residents who need booster dose: 

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* 5. Current number of employees (include full time, part time, contract, routine volunteers) who need booster dose:

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* 6. Facility Contact Name

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* 7. Facility Contact Phone Number 

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* 8. Facility Contact Email

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* 9. Please indicate which category below describes your readiness to administer booster doses:

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