Tasmanian Vaccination Service Provider Agreement

Draft Version: 1.0

Date: 18 October 2013

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Service Provider AgreementTasmanian Vaccination Service Provider Agreement between

Vaccination Service Provider

Name of Practice/Clinic/Local Government/Other Organisation:     

Name of CEO, Principal Doctor/s or Local Government General Manager:     

and

The Department of Health and Human Services

DECLARATION by Vaccination Service ProviderI declare that I am authorised to act on behalf of the above vaccination service provider organisation. I accept in full the terms and conditions of the Tasmanian Vaccination Distribution scheme.

Name       Position      

Signature       Date      Signature of witness       Name of

Witness      Witness Address       Witness

Occupation      

Signed for the Department of Health and Human Services

Name       Position      

Signature       Date      Signature of witness       Name of

Witness      Witness Address       Witness

Occupation      

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Provider Details

Vaccination Service ProviderName:      Account Number:      Type of Vaccination Service Provider:      

(e.g. General practice, or Local Government)Name and title of vaccine accountable officer:      

(e.g. Practice Principal, Business Owner or Local Government General Manager)

Approved RecipientName of person ordering or authorising the ordering of vaccines:      

Registered Medical Practitioner Authorised Nurse Immuniser or Pharmacist (please tick)A Tasmanian Vaccination Service Provider Authorisation to Order has been completed if applicable to this practice: Yes No

Contact DetailsPostal Address:      

Postcode:      Address for Vaccine Delivery:      

Opening Hours / Special Instructions:      

Email address for primary person responsible for ordering vaccine:      

Telephone:       Fax:      

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TERMS AND CONDITIONS relating to the Tasmanian Vaccination Distribution SchemeThe National Immunisation ProgramImmunisation is a simple, safe and effective way of protecting people against harmful diseases before they come into contact with them in the community. Immunisation not only protects individuals, but also others in the community, by reducing the spread of disease.

The Immunise Australia Program aims to increase national immunisation rates by funding free vaccination programs, administering the Australian Childhood Immunisation Register and communicating information about immunisation to the general public and health professionals.The Immunise Australia Program implements the National Immunisation Program (NIP) Schedule which currently includes vaccines against a total of 15 diseases in Tasmania. The Australian Government provides funding for:

State and Territory Governments to obtain vaccines listed on the National Immunisation Program (NIP) in accordance with the list of Designated Vaccines.

Medicare Australia for the Australian Childhood Immunisation Register (ACIR);

The Victorian Cytology Service for the administration of the National HPV Vaccination Program Register.

Vaccines on the National Immunisation Program (NIP) are issued to Tasmanian Vaccination Providers to allow providers to take every opportunity to vaccinate eligible children and adults.

Terms and Conditions relating to the Tasmanian Vaccination Distribution Scheme1. The Principal Officer signing the agreement is responsible and

accountable for this agreement.

2. In accordance with the Tasmanian Poisons Act 1971, only a registered Medical Practitioner, authorised Nurse Immuniser or Pharmacist is an approved recipient eligible to order vaccines supplied under the National Immunisation Program. This authority can be passed to another suitable person e.g. a Practice Nurse or Environmental Health Officer. If authority is given, a Tasmanian Vaccination Service Provider Authorisation to Order will be completed and retained by the Service Provider.

See Attachment 1 and available at http://www.dhhs.tas.gov.au/peh/immunisation

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3. Vaccines supplied under National Immunisation Program to the provider can only be used as per the Free Vaccines Supplied by DHHS Tasmania and their Indications for Use document supplied by the Department of Health and Human Services each year.

See Attachment 2 and available at http://www.dhhs.tas.gov.au/peh/immunisation

4. Vaccines provided through the government funded National Immunisation Program will be provided to Australian Medicare card holders only.

5. Vaccination programs will be conducted as per the guidelines in the current version of The Australian Immunisation Handbook.

http://health.gov.au/internet/immunise/publishing.nsf/Content/Handbook10-home

6. Vaccination programs utilising Authorised Nurse Immunisers not under the direct supervision of a Medical Practitioner must have a Program Approval signed by the Director of Public Health. It is the responsibility of the provider to ensure that this is renewed every two years.

Download the Guidelines for Providers Employing Nurse Immunisers application for a Program Approval at http://www.dhhs.tas.gov.au/peh/immunisation/information_for_immunisation_providers

7. Any changes in ownership of a practice, change in Practice Principal or Manager or movement of the authorising Medical Practitioner or Nurse Immuniser in or out of the practice must be notified to the Immunisation Section, Communicable Diseases Prevention Unit using a Change of Details form.

See Attachment 3 and available at http://www.dhhs.tas.gov.au/peh/immunisation

8. Approved Tasmanian Immunisation Providers will enter vaccine orders on to BioCSL’ s electronic web link ordering and distribution system with support from CDPU as necessary. The Web Based Ordering System is accessed at http://dhhstas.csldirect.com.au using a supplied log in and password.

9. In most cases vaccine requests should include all required funded vaccines for the coming month. Stock on hand quantities of vaccines remaining in refrigerator/s must be advised at the time of ordering as requested. Additional vaccine deliveries within a month may not be authorised by CDPU.

10. Vaccines will be stored as per the current edition of The National Vaccine Storage Guidelines Strive for 5, available at

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http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/IMM77-cnt

11. and any other relevant information published by the Department of Health and Ageing (Canberra) or the Department of Health and Human Services (Tasmania).

12. Each dose of vaccine administered to an eligible person will be notified promptly to the Australian Childhood Immunisation Register (ACIR) or the National HPV Vaccination Program Register as applicable.

13. Vaccines delivered to a provider become the responsibility of the provider, and in the event of vaccine loss due to a cold chain interruption, the provider may be asked to reimburse the costs of the vaccine to the Department of Health and Human Services. It is suggested that providers obtain insurance to cover this potential cost.

14. Immunisation staff from the Communicable Diseases Prevention Unit may undertake a site visit to providers to perform a cold chain audit, or collaborate with Tasmanian Medicare Local to arrange for a Practice visit.

15. Information requested by the Department of Health and Human Services (Tasmania) relating to vaccine distribution and immunisation coverage will be provided in the time frame requested.

16. If vaccine is affected by a Cold Chain breach (below 2°C or over 8°C), you must contact the Immunisation Section, CDPU on 1800 671 738 prior to using or discarding the affected vaccines.

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Attachment 1

Tasmanian Vaccination Service - Authorisation to Order1 July 2013- 30 June 2014

I, _________________________________________________________________

Registered Medical Practitioner / Authorised Nurse Immuniser (cross out non applicable),

providing services for___________________________________________ (Name of service)

authorise

______________________________________ (name) _____________________________

(position)

______________________________________ (name) _____________________________

(position)

to order on my behalf from the Department of Health and Human Services the

following National Immunisation Program vaccines, consistent with the quantities

specified:

Product Brand Names Maximum doses to order

Influenza Fluvax / Vaxigrip / FluarixInfluenza Junior Vaxigrip JuniordTpa BoostrixHPV GardasilHib HiberixDTPa/Hib/hepB/IPV Infanrix hexaDTPa/IPV Infanrix IPVMeningococcal C Meningitec / NeisVacCPneumococcal PneumovaxPneumococcal PrevenarMMR PriorixRotavirus RotarixVaricella Varilrix / VarivaxMMR /VaricellaHepatitis B Paed HBVaxII PaediatricHepatitis B Adult HBVaxII AdultMeningococcal C/ HibOther:

Signed___________________________________________ Date ______________________

If any of the parties named cease association with the Vaccination Service Provider, this delegation must be updated.

Please retain this document at your practice.

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Attachment 2

Department of Health and Human ServicesPopulation Health

FREE VACCINES SUPPLIED BY DHHS TASMANIA AND THEIR INDICATION FOR USE 2013

VACCINE INDICATION FOR USE

Adult Diphtheria & Tetanus (ADT Booster®)

Catch-up immunisation for 10 years of age and over, who have not had a primary course of diphtheria and tetanus, or have an incomplete history of diphtheria and tetanus immunisationsCall DHHS to discuss before ordering

Adult/Adolescent Diphtheria, Tetanus & acellular Pertussis

(Boostrix®)

Local councils offer Boostrix® in Year 7 of secondary school Catch-up Year 9 (2013-14) and 10 (2013)GPs are supplied a small quantity of Boostrix® for students who did not receive the vaccine through the school program

Diphtheria, Tetanus, Acellular Pertussis, Inactivated Polio,

Hepatitis B and Hib(Infanrix Hexa®)

2, 4 and 6 months of ageCatch-up to 9 years of age (inclusive)

Diphtheria, Tetanus, Acellular Pertussis & Inactivated Polio

(Infanrix IPV®)

3 ½ - 4 years of ageCatch-up to 9 years of age (inclusive)

Inactivated Poliomyelitis(IPOL®)

Individuals (aged 10 years and older) who are unimmunised or incompletely immunised for poliomyelitisCall DHHS to discuss before ordering

Meningococcal C/Haemophilus influenzae type b

(Menitorix®) 12 months of age

Hepatitis B adult(H-B Vax II Adult®) 12 to 13 years of age if not previously received – 2013 only

Hepatitis B paediatric (H-B Vax II Paediatric®)

Infants at birth and within 7 days of birth12 months of age booster dose if born less than 32 weeks gestation or less than 2000 g birth weight Catch-up to 9 years of age (inclusive)

Human Papilloma Virus (Gardasil®)

Year 7 school program (12-13 years of age only)Year 9 boys in school program (14 to 15 years of age) - time-limited 2013 and 2014Year 9 boys in school program (14 to 15 years of age) - time-limited 2013 and 2014

Influenza(Vaxigrip®/Fluvax®/Fluarix®)

6 months of age and over with conditions predisposing to severe illness following influenza infection 15 years of age and over for Aboriginal and Torres Strait Islander people All pregnant women during any stage of pregnancy 65 years of age and older

Measles, Mumps, Rubella(Priorix®/M-M-R II®) 12 months and 4 years of age

Measles, Mumps, Rubella / Varicella

(Priorix®-Tetra)18 months of age

Childhood Pneumococcal(Prevenar 13®)

2, 4, & 6 months of age12 months of age booster dose if underlying medical risk factors including born less than 28 weeks gestation Catch-up if less than 5 years of age

Pneumococcal(Pneumovax 23®)

4 to 5 years of age with underlying medical risk factors includes born less than 28 weeks gestation 15 to 49 years of age for Aboriginal and Torres Strait Islander people with underlying medical risk factors 50 years of age and over for Aboriginal and Torres Strait Islander people65 years of age and over

Rotavirus(Rotarix®)

2 and 4 months of ageNo catch-up for this vaccine outside this age group

Varicella (chickenpox)(Varilrix® or Varivax®) Year 7 school program (12-13 years of age only) if no history of disease

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Attachment 3Department of Health and Human ServicesCOMMUNICABLE DISEASES PREVENTION UNITIMMUNISATION SECTION

Tasmanian Vaccine Service Provider Change of Details Form

Service Provider DetailsAccount Number:      Business Name:      

New Business Name:      Existing Practice Principal/s, CEO or Manager:      

New owner, Practice Principal/s, CEO or Manager:      (A new Tasmanian Vaccination Service Provider Agreement should be completed and forwarded to the Communicable Diseases prevention Unit)

Approved Vaccine Recipient (Registered Medical Practitioner or Authorised Nurse Immuniser)Existing Approved Vaccine Recipient:      

New Approved Vaccine Recipient Name:      

AHPRA:       Expiry:      (A new Vaccine Service Provider Authorisation to Order should be completed and retained by your service if the new Approved Vaccine Recipient will allow another person to order on their behalf)

Address New address (indicate if business and/or delivery)

Street:      Suburb:       Post Code:      

Opening Hours New opening hours

Morning Afternoon

Opening Closing Opening Closing

Monday                        Tuesday                        Wednesday                        

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Thursday                        Friday                        

Please complete any changes and email to vaccineorder@dhhs.tas.gov.au

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