CHILDREN’S SERVICES HANDBOOK
APPENDIX B:
IMMUNIZATIONS
B.1 Immunizations Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . CH-328
B.1.1 Vaccine Adverse Event Reporting System (VAERS). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . CH-328
B.1.2 TVFC Versus Non-TVFC Vaccines/Toxoids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . CH-328
B.1.3 Exemption from Immunization for School and Child-Care Facilities . . . . . . . . . . . . . . CH-328
B.2 Recommended Childhood Immunization Schedule . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . CH-329
B.2.1 Recommended Childhood and Adolescent Immunization Schedule, 2010 . . . . . . . CH-330
B.3 General Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . CH-333
B.3.1 How to Obtain Free Vaccines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . CH-333
B.3.2 Administrations and Immunizations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . CH-333
B.3.2.1 Vaccine Procedure Codes and State-Defined Components . . . . . . . . . . . . . . . . . CH-333
B.3.3 Requirements for TVFC Providers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . CH-334
B.3.4 How to Report Immunization Records to ImmTrac, the Texas
Immunization RegistryCH-335
B.3.4.1 Direct Internet Entry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . CH-336
B.3.4.2 Electronic Data Transfer (Import) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . CH-336
B.3.4.3 Obtaining Parental Consent for Registry Participation . . . . . . . . . . . . . . . . . . . . . . CH-336
B.4 Texas Vaccines for Children Program Packet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . CH-336
CH-327
CPT ONLY - COPYRIGHT 2009 AMERICAN MEDICAL ASSOCIATION. ALL RIGHTS RESERVED.
TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 2
B.1 Immunizations Overview
Clients 17 years of age or younger must be immunized according to the Recommended Childhood
Immunization Schedule for the United States. The checkup provider is responsible for the administration of immunizations and may not refer clients to local health departments. The Department of State
Health Services (DSHS) requires that immunizations be administered during the Texas Health Steps
(THSteps) medical checkup, unless they are medically contraindicated or excluded from immunization
for reasons of conscience, including a religious belief.
Providers, in both public and private sectors, are required by federal mandate to provide a Vaccine
Information Statement (VIS) to the responsible adult accompanying a client for an immunization. These
statements are specific to each vaccine and inform the responsible adult about the risks and benefits. It
is important that providers use the most current VIS.
Providers interested in obtaining copies of current VISs and other immunization forms or literature may
call the DSHS Immunization Branch at 1-512-458-7284. VISs may also be downloaded from the DSHS
Immunization Branch’s website at www.immunizetexas.com.
B.1.1 Vaccine Adverse Event Reporting System (VAERS)
The National Childhood Vaccine Injury Act of 1986 (NCVIA) requires health-care providers to report:
• Any reaction listed by the vaccine manufacturer as a contraindication to subsequent doses of the
vaccine.
• Any reaction listed in the Reportable Events Table that occurs within the specified time period after
vaccination.
Clinically significant adverse events should be reported even if it is unclear whether a vaccine caused the
event.
Note: Documentation of the injection site is recommended but not required.
For additional information regarding documentation, providers can refer to
www.hrsa.gov/vaccinecompensation/filing_claim.htm and
www.cdc.gov/od/science/iso/professional_info/providers_role.htm.
A copy of the Reportable Events Table can be obtained by calling VAERS at 1-800-822-7967 or by
downloading it from http://vaers.hhs.gov/resources/vaersmaterialspublications.
B.1.2 TVFC Versus Non-TVFC Vaccines/Toxoids
When single antigen vaccine(s)/toxoid(s) or comparable antigen vaccine(s)/toxoid(s) are available for
distribution through the Texas Vaccines for Children (TVFC) Program, but the provider chooses to use
a different Advisory Committee on Immunization Practices (ACIP)-recommended product, the
vaccine/toxoid will not be reimbursed; however, the administration fee will be considered.
Note: All administered vaccines/toxoids must be reported to DSHS. DSHS submits all
vaccines/toxoids reported with parental consent to a centralized repository of immunization
histories for clients 17 years of age or younger. This repository is known in Texas as ImmTrac.
Refer to: Subsection B.3.4, “How to Report Immunization Records to ImmTrac, the Texas Immunization Registry” in this Appendix.
B.1.3 Exemption from Immunization for School and Child-Care Facilities
Parents may choose not to vaccinate their children. Immunization requirements for school and childcare entry offer an exemption from these requirements for reasons of conscience or religious beliefs. An
exemption is also available for clients who are medically contraindicated from receiving a vaccine. For
more information on exemptions call 1-512-458-7284, or visit www.immunizetexas.com.
Refer to: Section 6, “THSteps Medical” in this handbook.
CH-328
CPT ONLY - COPYRIGHT 2009 AMERICAN MEDICAL ASSOCIATION. ALL RIGHTS RESERVED.
CHILDREN’S SERVICES HANDBOOK
B.2 Recommended Childhood Immunization Schedule
The Recommended Childhood Immunization Schedule indicates the recommended age for routine
administration of currently licensed childhood vaccines. This schedule is approved by the ACIP, the
American Academy of Pediatrics (AAP), and the American Academy of Family Physicians (AAFP).
Some combination vaccines are available and may be used whenever any component of the combination
is indicated and its other components are not contraindicated. Providers should consult the manufacturers package insert for detailed recommendations.
Vaccines should be administered at recommended ages. Any dose not given at the recommended age
should be given as a catch-up immunization on any subsequent visit when indicated and feasible.
A current copy of the Recommended Childhood Immunization Schedule can be accessed at
www.cdc.gov/vaccines/recs/schedules/default.htm.
CH-329
CPT ONLY - COPYRIGHT 2009 AMERICAN MEDICAL ASSOCIATION. ALL RIGHTS RESERVED.
TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 2
B.2.1 Recommended Childhood and Adolescent Immunization Schedule, 2010
Recommended Immunization Schedule for Persons Aged 0 Through 6 Years—6OJUFE4UBUFTt
'PSUIPTFXIPGBMMCFIJOEPSTUBSUMBUFTFFUIFDBUDIVQTDIFEVMF
Vaccine ź
Age Ź
)FQBUJUJT#1
Birth
HepB
2
1
month
2
4
6
12
15
18
19–23
months months months months months months months
HepB
4–6
years
HepB
RV
Rotavirus
2–3
years
RV
RV 2
see
footnote 3
DTaP
Diphtheria, Tetanus, Pertussis
DTaP
DTaP
DTaP
Haemophilus influenzae type b4
Hib
Hib
Hib4
Hib
Pneumococcal5
PCV
PCV
PCV
PCV
Inactivated Poliovirus6
IPV
IPV
DTaP
PPSV
IPV
IPV
Influenza (Yearly)
Influenza7
Measles, Mumps, Rubella
9
Varicella
)FQBUJUJT"10
Range of
recommended
ages for all
DIJMESFOFYDFQU
DFSUBJOIJHISJTL
groups
MMR
see footnote 8
Varicella
see footnote 9
HepA (2 doses)
Meningococcal11
MMR
Range of
recommended
ages for certain
IJHISJTLHSPVQT
Varicella
HepA Series
MCV
Committee on Immunization Practices statement for detailed recommendations:
http://www.cdc.gov/vaccines/pubs/acip-list.htm. Clinically significant adverse
events that follow immunization should be reported to the Vaccine Adverse Event
Reporting System (VAERS) at http://www.vaers.hhs.gov or by telephone,
800-822-7967.
1. Hepatitis B vaccine (HepB). (Minimum age: birth)
At birth:
r "ENJOJTUFSNPOPWBMFOU)FQ#UPBMMOFXCPSOTCFGPSFIPTQJUBMEJTDIBSHF
r *GNPUIFSJTIFQBUJUJT#TVSGBDFBOUJHFO)#T"H
QPTJUJWFBENJOJTUFS)FQ#
BOEN-PGIFQBUJUJT#JNNVOFHMPCVMJO)#*(
XJUIJOIPVSTPGCJSUI
r *GNPUIFST)#T"HTUBUVTJTVOLOPXOBENJOJTUFS)FQ#XJUIJOIPVSTPG
CJSUI%FUFSNJOFNPUIFST)#T"HTUBUVTBTTPPOBTQPTTJCMFBOEJG)#T"H
QPTJUJWFBENJOJTUFS)#*(OPMBUFSUIBOBHFXFFL
After the birth dose:
r 5IF)FQ#TFSJFTTIPVMECFDPNQMFUFEXJUIFJUIFSNPOPWBMFOU)FQ#PSBDPN
CJOBUJPOWBDDJOFDPOUBJOJOH)FQ#5IFTFDPOEEPTFTIPVMECFBENJOJTUFSFE
BUBHFPSNPOUIT.POPWBMFOU)FQ#WBDDJOFTIPVMECFVTFEGPSEPTFT
BENJOJTUFSFECFGPSFBHFXFFLT5IFàOBMEPTFTIPVMECFBENJOJTUFSFEOP
FBSMJFSUIBOBHFXFFLT
r *OGBOUT CPSO UP )#T"HQPTJUJWF NPUIFST TIPVME CF UFTUFE GPS )#T"H BOE
BOUJCPEZUP)#T"HUPNPOUITBGUFSDPNQMFUJPOPGBUMFBTUEPTFTPGUIF
)FQ#TFSJFTBUBHFUISPVHINPOUITHFOFSBMMZBUUIFOFYUXFMMDIJME
visit).
r "ENJOJTUSBUJPOPGEPTFTPG)FQ#UPJOGBOUTJTQFSNJTTJCMFXIFOBDPNCJOB
UJPOWBDDJOFDPOUBJOJOH)FQ#JTBENJOJTUFSFEBGUFSUIFCJSUIEPTF5IFGPVSUI
EPTFTIPVMECFBENJOJTUFSFEOPFBSMJFSUIBOBHFXFFLT
2. Rotavirus vaccine (RV)..JOJNVNBHFXFFLT
r "ENJOJTUFS UIF àSTU EPTF BU BHF UISPVHI XFFLT NBYJNVN BHF XFFLTEBZT
7BDDJOBUJPOTIPVMEOPUCFJOJUJBUFEGPSJOGBOUTBHFEXFFLT
0 days or older.
r 5IFNBYJNVNBHFGPSUIFàOBMEPTFJOUIFTFSJFTJTNPOUITEBZT
r *G3PUBSJYJTBENJOJTUFSFEBUBHFTBOENPOUITBEPTFBUNPOUITJTOPU
indicated.
3. Diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP).
.JOJNVNBHFXFFLT
r 5IFGPVSUIEPTFNBZCFBENJOJTUFSFEBTFBSMZBTBHFNPOUITQSPWJEFE
at least 6 months have elapsed since the third dose.
r "ENJOJTUFSUIFàOBMEPTFJOUIFTFSJFTBUBHFUISPVHIZFBST
4. Haemophilus influenzae type b conjugate vaccine (Hib).
.JOJNVNBHFXFFLT
r *G1310.11FEWBY)*#PS$PNWBY<)FQ#)JC>
JTBENJOJTUFSFEBUBHFT
and 4 months, a dose at age 6 months is not indicated.
r 5SJ)J#JU%5B1)JC
BOE)JCFSJY1315
TIPVMEOPUCFVTFEGPSEPTFTBUBHFT
2, 4, or 6 months for the primary series but can be used as the final dose in
children aged 12 months through 4 years. See MMWR/P33
5. Pneumococcal vaccine. .JOJNVNBHFXFFLTGPSQOFVNPDPDDBMDPOKVHBUF
WBDDJOF<1$7>ZFBSTGPSQOFVNPDPDDBMQPMZTBDDIBSJEFWBDDJOF<1147>
r 1$7JTSFDPNNFOEFEGPSBMMDIJMESFOBHFEZPVOHFSUIBOZFBST"ENJOJTUFS
1 dose of PCV to all healthy children aged 24 through 59 months who are
not completely vaccinated for their age.
r "ENJOJTUFS1147PSNPSFNPOUITBGUFSMBTUEPTFPG1$7UPDIJMESFOBHFE
years or older with certain underlying medical conditions, including a cochlear
implant.
6. Inactivated poliovirus vaccine (IPV) .JOJNVNBHFXFFLT
r 5IF àOBM EPTF JO UIF TFSJFT TIPVME CF BENJOJTUFSFE PO PS BGUFS UIF GPVSUI
birthday and at least 6 months following the previous dose.
r *GEPTFTBSFBENJOJTUFSFEQSJPSUPBHFZFBSTBàGUIEPTFTIPVMECFBENJO
istered at age 4 through 6 years. See MMWR
m
7. Influenza vaccine (seasonal). (Minimum age: 6 months for trivalent inacti
WBUFEJOáVFO[BWBDDJOF<5*7>ZFBSTGPSMJWFBUUFOVBUFEJOáVFO[BWBDDJOF
<-"*7>
r "ENJOJTUFSBOOVBMMZUPDIJMESFOBHFENPOUITUISPVHIZFBST
r 'PSIFBMUIZDIJMESFOBHFEUISPVHIZFBSTJFUIPTFXIPEPOPUIBWFVOEFS
lying medical conditions that predispose them to influenza complications),
FJUIFS-"*7PS5*7NBZCFVTFEFYDFQU-"*7TIPVMEOPUCFHJWFOUPDIJMESFO
aged 2 through 4 years who have had wheezing in the past 12 months.
r $IJMESFOSFDFJWJOH5*7TIPVMESFDFJWFN-JGBHFEUISPVHINPOUIT
PSN-JGBHFEZFBSTPSPMEFS
r "ENJOJTUFSEPTFTTFQBSBUFECZBUMFBTUXFFLT
UPDIJMESFOBHFEZPVOHFS
than 9 years who are receiving influenza vaccine for the first time or who were
vaccinated for the first time during the previous influenza season but only
received 1 dose.
r 'PSSFDPNNFOEBUJPOTGPSVTFPGJOáVFO[B")/
NPOPWBMFOUWBDDJOF
see MMWR/P33
8. Measles, mumps, and rubella vaccine (MMR). (Minimum age: 12 months)
r "ENJOJTUFSUIFTFDPOEEPTFSPVUJOFMZBUBHFUISPVHIZFBST)PXFWFSUIF
TFDPOEEPTFNBZCFBENJOJTUFSFECFGPSFBHFQSPWJEFEBUMFBTUEBZT
have elapsed since the first dose.
9. Varicella vaccine. (Minimum age: 12 months)
r "ENJOJTUFSUIFTFDPOEEPTFSPVUJOFMZBUBHFUISPVHIZFBST)PXFWFSUIF
TFDPOEEPTFNBZCFBENJOJTUFSFECFGPSFBHFQSPWJEFEBUMFBTUNPOUIT
have elapsed since the first dose.
r 'PSDIJMESFOBHFENPOUITUISPVHIZFBSTUIFNJOJNVNJOUFSWBMCFUXFFO
EPTFTJTNPOUIT)PXFWFSJGUIFTFDPOEEPTFXBTBENJOJTUFSFEBUMFBTU
EBZTBGUFSUIFàSTUEPTFJUDBOCFBDDFQUFEBTWBMJE
10. Hepatitis A vaccine (HepA). (Minimum age: 12 months)
r "ENJOJTUFS UP BMM DIJMESFO BHFE ZFBS JF BHFE UISPVHI NPOUIT
Administer 2 doses at least 6 months apart.
r $IJMESFOOPUGVMMZWBDDJOBUFECZBHFZFBSTDBOCFWBDDJOBUFEBUTVCTFRVFOU
visits
r )FQ"BMTPJTSFDPNNFOEFEGPSPMEFSDIJMESFOXIPMJWFJOBSFBTXIFSFWBD
DJOBUJPOQSPHSBNTUBSHFUPMEFSDIJMESFOXIPBSFBUJODSFBTFESJTLGPSJOGFDUJPO
or for whom immunity against hepatitis A is desired.
11.Meningococcal vaccine. (Minimum age: 2 years for meningococcal conjugate
WBDDJOF<.$7>BOEGPSNFOJOHPDPDDBMQPMZTBDDIBSJEFWBDDJOF<.147>
r "ENJOJTUFS.$7UPDIJMESFOBHFEUISPVHIZFBSTXJUIQFSTJTUFOUDPNQMF
ment component deficiency, anatomic or functional asplenia, and certain other
DPOEJUJPOTQMBDJOHUIBNBUIJHISJTL
r "ENJOJTUFS .$7 UP DIJMESFO QSFWJPVTMZ WBDDJOBUFE XJUI .$7 PS .147
BGUFSZFBSTJGàSTUEPTFBENJOJTUFSFEBUBHFUISPVHIZFBST4FFMMWR
m
$4"
This schedule includes recommendations in effect as of December 15, 2009.
Any dose not administered at the recommended age should be administered at a
subsequent visit, when indicated and feasible. The use of a combination vaccine
generally is preferred over separate injections of its equivalent component vaccines.
Considerations should include provider assessment, patient preference, and
the potential for adverse events. Providers should consult the relevant Advisory
5IF3FDPNNFOEFE*NNVOJ[BUJPO4DIFEVMFTGPS1FSTPOT"HFEUISPVHI:FBSTBSFBQQSPWFECZUIF"EWJTPSZ$PNNJUUFFPO*NNVOJ[BUJPO1SBDUJDFT
(http://www.cdc.gov/vaccines/recs/acip), the American Academy of Pediatrics (http://www.aap.org
BOEUIF"NFSJDBO"DBEFNZPG'BNJMZ1IZTJDJBOThttp://www.aafp.org).
%FQBSUNFOUPG)FBMUIBOE)VNBO4FSWJDFTr$FOUFSTGPS%JTFBTF$POUSPMBOE1SFWFOUJPO
CH-330
CPT ONLY - COPYRIGHT 2009 AMERICAN MEDICAL ASSOCIATION. ALL RIGHTS RESERVED.
CHILDREN’S SERVICES HANDBOOK
Recommended Immunization Schedule for Persons Aged 7 ThroVHI:FBST— 6OJUFE4UBUFTr
'PSUIPTFXIPGBMMCFIJOEPSTUBSUMBUFTFFUIFTDIFEVMFCFMPXBOEUIFDBUDIVQTDIFEVMF
Vaccine ź
AgeŹ
7–10 years
11–12 years
13–18 years
Tdap
Tdap
see footnote 2
HPV (3 doses)
HPV series
MCV
MCV
MCV
Tetanus, Diphtheria, Pertussis1
)VNBO1BQJMMPNBWJSVT2
Meningococcal
Influenza4
Influenza (Yearly)
Pneumococcal5
PPSV
6
HepA Series
)FQBUJUJT"
)FQBUJUJT#7
Hep B Series
Inactivated Poliovirus
IPV Series
Measles, Mumps, Rubella9
MMR Series
$4"
Varicella10
Varicella Series
Range of
recommended
ages for all
DIJMESFOFYDFQU
DFSUBJOIJHISJTL
groups
Range of
recommended
ages for
DBUDIVQ
immunization
Range of
recommended
ages for certain
IJHISJTLHSPVQT
This schedule includes recommendations in effect as of December 15, 2009.
Any dose not administered at the recommended age should be administered at a
subsequent visit, when indicated and feasible. The use of a combination vaccine
generally is preferred over separate injections of its equivalent component vaccines.
Considerations should include provider assessment, patient preference, and
the potential for adverse events. Providers should consult the relevant Advisory
Committee on Immunization Practices statement for detailed recommendations:
http://www.cdc.gov/vaccines/pubs/acip-list.htm. Clinically significant adverse
events that follow immunization should be reported to the Vaccine Adverse Event
Reporting System (VAERS) at http://www.vaers.hhs.gov or by telephone,
800-822-7967.
1. Tetanus and diphtheria toxoids and acellular pertussis vaccine (Tdap).
.JOJNVNBHFZFBSTGPS#PPTUSJYBOEZFBSTGPS"EBDFM
r "ENJOJTUFSBUBHFPSZFBSTGPSUIPTFXIPIBWFDPNQMFUFEUIFSFDPN
NFOEFE DIJMEIPPE %51%5B1 WBDDJOBUJPO TFSJFT BOE IBWF OPU SFDFJWFE B
UFUBOVTBOEEJQIUIFSJBUPYPJE5E
CPPTUFSEPTF
r 1FSTPOTBHFEUISPVHIZFBSTXIPIBWFOPUSFDFJWFE5EBQTIPVMESFDFJWF
a dose.
r "ZFBSJOUFSWBMGSPNUIFMBTU5EEPTFJTFODPVSBHFEXIFO5EBQJTVTFEBT
a booster dose; however, a shorter interval may be used if pertussis immunity
is needed.
2. Human papillomavirus vaccine (HPV). (Minimum age: 9 years)
r 5XP)17WBDDJOFTBSFMJDFOTFEBRVBESJWBMFOUWBDDJOF)17
GPSUIFQSF
vention of cervical, vaginal and vulvar cancers (in females) and genital warts
JOGFNBMFTBOENBMFT
BOEBCJWBMFOUWBDDJOF)17
GPSUIFQSFWFOUJPOPG
cervical cancers in females.
r )17 WBDDJOFT BSF NPTU FGGFDUJWF GPS CPUI NBMFT BOE GFNBMFT XIFO HJWFO
CFGPSFFYQPTVSFUP)17UISPVHITFYVBMDPOUBDU
r )17PS)17JTSFDPNNFOEFEGPSUIFQSFWFOUJPOPGDFSWJDBMQSFDBODFSTBOE
cancers in females.
r )17 JT SFDPNNFOEFE GPS UIF QSFWFOUJPO PG DFSWJDBM WBHJOBM BOE WVMWBS
precancers and cancers and genital warts in females.
r "ENJOJTUFSUIFàSTUEPTFUPGFNBMFTBUBHFPSZFBST
r "ENJOJTUFSUIFTFDPOEEPTFUPNPOUITBGUFSUIFàSTUEPTFBOEUIFUIJSE
EPTFNPOUITBGUFSUIFàSTUEPTFBUMFBTUXFFLTBGUFSUIFàSTUEPTF
r "ENJOJTUFSUIFTFSJFTUPGFNBMFTBUBHFUISPVHIZFBSTJGOPUQSFWJPVTMZ
vaccinated.
r )17NBZCFBENJOJTUFSFEJOBEPTFTFSJFTUPNBMFTBHFEUISPVHI
ZFBSTUPSFEVDFUIFJSMJLFMJIPPEPGBDRVJSJOHHFOJUBMXBSUT
3. Meningococcal conjugate vaccine (MCV4).
r "ENJOJTUFSBUBHFPSZFBSTPSBUBHFUISPVHIZFBSTJGOPUQSFWJ
ously vaccinated.
r "ENJOJTUFS UP QSFWJPVTMZ VOWBDDJOBUFE DPMMFHF GSFTINFO MJWJOH JO B
dormitory.
r "ENJOJTUFS.$7UPDIJMESFOBHFEUISPVHIZFBSTXJUIQFSTJTUFOUDPNQMF
ment component deficiency, anatomic or functional asplenia, or certain other
DPOEJUJPOTQMBDJOHUIFNBUIJHISJTL
r "ENJOJTUFS UP DIJMESFO QSFWJPVTMZ WBDDJOBUFE XJUI .$7 PS .147 XIP
SFNBJO BU JODSFBTFE SJTL BGUFS ZFBST JG àSTU EPTF BENJOJTUFSFE BU BHF through 6 years) or after 5 years (if first dose administered at age 7 years or
PMEFS
1FSTPOTXIPTFPOMZSJTLGBDUPSJTMJWJOHJOPODBNQVTIPVTJOHBSFOPU
recommended to receive an additional dose. See MMWRm
4. Influenza vaccine (seasonal).
r "ENJOJTUFSBOOVBMMZUPDIJMESFOBHFENPOUITUISPVHIZFBST
r 'PSIFBMUIZOPOQSFHOBOUQFSTPOTBHFEUISPVHIZFBSTJFUIPTFXIP
do not have underlying medical conditions that predispose them to influenza
complications), either LAIV or TIV may be used.
r "ENJOJTUFSEPTFTTFQBSBUFECZBUMFBTUXFFLT
UPDIJMESFOBHFEZPVOHFS
than 9 years who are receiving influenza vaccine for the first time or who were
vaccinated for the first time during the previous influenza season but only
received 1 dose.
r 'PSSFDPNNFOEBUJPOTGPSVTFPGJOáVFO[B")/
NPOPWBMFOUWBDDJOF
See MMWR/P33
5. Pneumococcal polysaccharide vaccine (PPSV).
r "ENJOJTUFSUPDIJMESFOXJUIDFSUBJOVOEFSMZJOHNFEJDBMDPOEJUJPOTJODMVEJOHB
cochlear implant. A single revaccination should be administered after 5 years
to children with functional or anatomic asplenia or an immunocompromising
condition. See MMWR /P33
6. Hepatitis A vaccine (HepA).
r "ENJOJTUFSEPTFTBUMFBTUNPOUITBQBSU
r )FQ"JTSFDPNNFOEFEGPSDIJMESFOBHFEPMEFSUIBONPOUITXIPMJWFJO
areas where vaccination programs target older children or who are at increased
SJTLGPSJOGFDUJPOPSGPSXIPNJNNVOJUZBHBJOTUIFQBUJUJT"JTEFTJSFE
7. Hepatitis B vaccine (HepB).
r "ENJOJTUFSUIFEPTFTFSJFTUPUIPTFOPUQSFWJPVTMZWBDDJOBUFE
r " EPTF TFSJFT TFQBSBUFE CZ BU MFBTU NPOUIT
PG BEVMU GPSNVMBUJPO
3FDPNCJWBY)#JTMJDFOTFEGPSDIJMESFOBHFEUISPVHIZFBST
8. Inactivated poliovirus vaccine (IPV).
r 5IF àOBM EPTF JO UIF TFSJFT TIPVME CF BENJOJTUFSFE PO PS BGUFS UIF GPVSUI
birthday and at least 6 months following the previous dose.
r *GCPUI017BOE*17XFSFBENJOJTUFSFEBTQBSUPGBTFSJFTBUPUBMPGEPTFT
TIPVMECFBENJOJTUFSFESFHBSEMFTTPGUIFDIJMETDVSSFOUBHF
9. Measles, mumps, and rubella vaccine (MMR).
r *GOPUQSFWJPVTMZWBDDJOBUFEBENJOJTUFSEPTFTPSUIFTFDPOEEPTFGPSUIPTF
XIPIBWFSFDFJWFEPOMZEPTFXJUIBUMFBTUEBZTCFUXFFOEPTFT
10. Varicella vaccine.
r 'PS QFSTPOT BHFE UISPVHI ZFBST XJUIPVU FWJEFODF PG JNNVOJUZ TFF
MMWR</P33>
BENJOJTUFSEPTFTJGOPUQSFWJPVTMZWBDDJOBUFE
or the second dose if only 1 dose has been administered.
r 'PSQFSTPOTBHFEUISPVHIZFBSTUIFNJOJNVNJOUFSWBMCFUXFFOEPTFT
JTNPOUIT)PXFWFSJGUIFTFDPOEEPTFXBTBENJOJTUFSFEBUMFBTUEBZT
after the first dose, it can be accepted as valid.
r 'PSQFSTPOTBHFEZFBSTBOEPMEFSUIFNJOJNVNJOUFSWBMCFUXFFOEPTFT
JTEBZT
5IF3FDPNNFOEFE*NNVOJ[BUJPO4DIFEVMFTGPS1FSTPOT"HFEUISPVHI:FBSTBSFBQQSPWFECZUIF"EWJTPSZ$PNNJUUFFPO*NNVOJ[BUJPO1SBDUJDFT
(http://www.cdc.gov/vaccines/recs/acip), the American Academy of Pediatrics (http://www.aap.org
BOEUIF"NFSJDBO"DBEFNZPG'BNJMZ1IZTJDJBOThttp://www.aafp.org).
%FQBSUNFOUPG)FBMUIBOE)VNBO4FSWJDFTr$FOUFSTGPS%JTFBTF$POUSPMBOE1SFWFOUJPO
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TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 2
$BUDIVQ*NNVOJ[BUJPO4DIFEVMFGPS1FSTPOT"HFE.POUIT5ISPVHI:FBST8IP4UBSU-BUFPS8IP"SF.PSF5IBO.POUI#FIJOE—United States t
The table below provides catch-up schedules and minimum intervals between doses for children whose vaccinations have been delayed. A vaccine
series does not need to be restarted, regardless of the time that has elapsed between doses. Use the section appropriate for the child’s age.
PERSONS AGED 4 MONTHS THROUGH 6 YEARS
Minimum Interval Between Doses
Dose 2 to Dose 3
Minimum Age
for Dose 1
Dose 1 to Dose 2
)FQBUJUJT#1
#JSUI
4 weeks
8 weeks
BOEBUMFBTUXFFLTBGUFSàSTUEPTF
Rotavirus2
XLT
4 weeks
4 weeks2
Diphtheria, Tetanus, Pertussis
XLT
4 weeks
4 weeks
4 weeks
if first dose administered at younger than age 12 months
4 weeks4
if current age is younger than 12 months
8 weeks (as final dose)
JGàSTUEPTFBENJOJTUFSFEBUBHFmNPOUIT
8 weeks (as final dose)4
if current age is 12 months or older and first dose
administered at younger than age 12 months and
second dose administered at younger than 15 months
Vaccine
Haemophilus influenzae type b4
XLT
No further doses needed
if first dose administered at age 15 months or older
No further doses needed
if previous dose administered at age 15 months or older
Pneumococcal5
Inactivated Poliovirus6
XLT
4 weeks
if first dose administered at younger than age 12 months
4 weeks
if current age is younger than 12 months
8 weeks (as final dose for healthy children)
if first dose administered at age 12 months or older
or current age 24 through 59 months
8 weeks
(as final dose for healthy children)
if current age is 12 months or older
No further doses needed
for healthy children if first dose
administered at age 24 months or older
No further doses needed
for healthy children if previous dose administered at age
24 months or older
4 weeks
XLT
4 weeks
Measles,Mumps, Rubella7
12 mos
4 weeks
Varicella
12 mos
3 months
)FQBUJUJT"9
12 mos
6 months
Dose 3 to Dose 4
Dose 4 to Dose 5
6 months
6 months3
8 weeks (as final dose)
This dose only necessary
for children aged 12 months
through 59 months who
SFDFJWFEEPTFTCFGPSF
age 12 months
8 weeks (as final dose)
This dose only necessary
for children aged 12 months
through 59 months who
SFDFJWFEEPTFTCFGPSF
BHFNPOUITPSGPSIJHI
SJTLDIJMESFOXIPSFDFJWFE
EPTFTBUBOZBHF
6 months
PERSONS AGED 7 THROUGH 18 YEARS
5FUBOVT%JQIUIFSJB
Tetanus,Diphtheria,Pertussis10
)VNBO1BQJMMPNBWJSVT11
)FQBUJUJT"9
7 yrs10
4 weeks
6 months
if first dose administered at 12 months or older
6 months
if first dose administered at
younger than age 12 months
Routine dosing intervals are recommended11
9 yrs
12 mos
6 months
)FQBUJUJT#1
#JSUI
4 weeks
8 weeks
BOEBUMFBTUXFFLTBGUFSàSTUEPTF
Inactivated Poliovirus6
XLT
4 weeks
4 weeks
Measles,Mumps, Rubella7
12 mos
4 weeks
Varicella
12 mos
6 months
3 months
JGQFSTPOJTZPVOHFSUIBOBHFZFBST
4 weeks
JGQFSTPOJTBHFEZFBSTPSPMEFS
1. Hepatitis B vaccine (HepB).
r "ENJOJTUFSUIFEPTFTFSJFTUPUIPTFOPUQSFWJPVTMZWBDDJOBUFE
r "EPTFTFSJFTTFQBSBUFECZBUMFBTUNPOUIT
PGBEVMUGPSNVMBUJPO3FDPNCJWBY
)#JTMJDFOTFEGPSDIJMESFOBHFEUISPVHIZFBST
2. Rotavirus vaccine (RV).
r 5IFNBYJNVNBHFGPSUIFàSTUEPTFJTXFFLTEBZT7BDDJOBUJPOTIPVMEOPUCF
JOJUJBUFEGPSJOGBOUTBHFEXFFLTEBZTPSPMEFS
r 5IFNBYJNVNBHFGPSUIFàOBMEPTFJOUIFTFSJFTJTNPOUITEBZT
r *G 3PUBSJY XBT BENJOJTUFSFE GPS UIF àSTU BOE TFDPOE EPTFT B UIJSE EPTF JT OPU
indicated.
3. Diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP).
r 5IFàGUIEPTFJTOPUOFDFTTBSZJGUIFGPVSUIEPTFXBTBENJOJTUFSFEBUBHFZFBST
or older.
4. Haemophilus influenzae type b conjugate vaccine (Hib).
r )JCWBDDJOFJTOPUHFOFSBMMZSFDPNNFOEFEGPSQFSTPOTBHFEZFBSTPSPMEFS/P
efficacy data are available on which to base a recommendation concerning use of
)JCWBDDJOFGPSPMEFSDIJMESFOBOEBEVMUT)PXFWFSTUVEJFTTVHHFTUHPPEJNNV
OPHFOJDJUZJOQFSTPOTXIPIBWFTJDLMFDFMMEJTFBTFMFVLFNJBPS)*7JOGFDUJPOPS
XIPIBWFIBEBTQMFOFDUPNZBENJOJTUFSJOHEPTFPG)JCWBDDJOFUPUIFTFQFSTPOT
XIPIBWFOPUQSFWJPVTMZSFDFJWFE)JCWBDDJOFJTOPUDPOUSBJOEJDBUFE
r *GUIFàSTUEPTFTXFSF1310.11FEWBY)*#PS$PNWBY
BOEBENJOJTUFSFEBU
age 11 months or younger, the third (and final) dose should be administered at
BHFUISPVHINPOUITBOEBUMFBTUXFFLTBGUFSUIFTFDPOEEPTF
r *GUIFàSTUEPTFXBTBENJOJTUFSFEBUBHFUISPVHINPOUITBENJOJTUFSUIFTFDPOE
EPTFBUMFBTUXFFLTMBUFSBOEBàOBMEPTFBUBHFUISPVHINPOUIT
5. Pneumococcal vaccine.
r "ENJOJTUFSEPTFPGQOFVNPDPDDBMDPOKVHBUFWBDDJOF1$7
UPBMMIFBMUIZDIJMESFO
aged 24 through 59 months who have not received at least 1 dose of PCV on or
after age 12 months.
r 'PSDIJMESFOBHFEUISPVHINPOUITXJUIVOEFSMZJOHNFEJDBMDPOEJUJPOTBENJO
JTUFSEPTFPG1$7JGEPTFTXFSFSFDFJWFEQSFWJPVTMZPSBENJOJTUFSEPTFTPG
1$7BUMFBTUXFFLTBQBSUJGGFXFSUIBOEPTFTXFSFSFDFJWFEQSFWJPVTMZ
r "ENJOJTUFSQOFVNPDPDDBMQPMZTBDDIBSJEFWBDDJOF1147
UPDIJMESFOBHFEZFBST
or older with certain underlying medical conditions, including a cochlear implant,
BUMFBTUXFFLTBGUFSUIFMBTUEPTFPG1$7
6. Inactivated poliovirus vaccine (IPV).
r 5IFàOBMEPTFJOUIFTFSJFTTIPVMECFBENJOJTUFSFEPOPSBGUFSUIFGPVSUICJSUIEBZ
and at least 6 months following the previous dose.
$4"
4 weeks
if first dose administered at younger than age 12 months
r "GPVSUIEPTFJTOPUOFDFTTBSZJGUIFUIJSEEPTFXBTBENJOJTUFSFEBUBHFZFBST
or older and at least 6 months following the previous dose.
r *OUIFàSTUNPOUITPGMJGFNJOJNVNBHFBOENJOJNVNJOUFSWBMTBSFPOMZSFDPN
NFOEFEJGUIFQFSTPOJTBUSJTLGPSJNNJOFOUFYQPTVSFUPDJSDVMBUJOHQPMJPWJSVTJF
USBWFMUPBQPMJPFOEFNJDSFHJPOPSEVSJOHBOPVUCSFBL
7. Measles, mumps, and rubella vaccine (MMR).
r "ENJOJTUFSUIFTFDPOEEPTFSPVUJOFMZBUBHFUISPVHIZFBST)PXFWFSUIFTFDPOE
EPTFNBZCFBENJOJTUFSFECFGPSFBHFQSPWJEFEBUMFBTUEBZTIBWFFMBQTFE
since the first dose.
r *G OPU QSFWJPVTMZ WBDDJOBUFE BENJOJTUFS EPTFT XJUI BU MFBTU EBZT CFUXFFO
doses.
8. Varicella vaccine.
r "ENJOJTUFSUIFTFDPOEEPTFSPVUJOFMZBUBHFUISPVHIZFBST)PXFWFSUIFTFDPOE
EPTFNBZCFBENJOJTUFSFECFGPSFBHFQSPWJEFEBUMFBTUNPOUITIBWFFMBQTFE
since the first dose.
r 'PS QFSTPOT BHFE NPOUIT UISPVHI ZFBST UIF NJOJNVN JOUFSWBM CFUXFFO
EPTFTJTNPOUIT)PXFWFSJGUIFTFDPOEEPTFXBTBENJOJTUFSFEBUMFBTUEBZT
after the first dose, it can be accepted as valid.
r 'PSQFSTPOTBHFEZFBSTBOEPMEFSUIFNJOJNVNJOUFSWBMCFUXFFOEPTFTJT
days.
9. Hepatitis A vaccine (HepA).
r )FQ"JTSFDPNNFOEFEGPSDIJMESFOPMEFSUIBONPOUITXIPMJWFJOBSFBTXIFSF
WBDDJOBUJPOQSPHSBNTUBSHFUPMEFSDIJMESFOXIPBSFBUJODSFBTFESJTLGPSJOGFDUJPO
or for whom immunity against hepatitis A is desired.
10.Tetanus and diphtheria toxoids vaccine (Td) and tetanus
and diphtheria toxoids and acellular pertussis vaccine (Tdap).
r %PTFTPG%5B1BSFDPVOUFEBTQBSUPGUIF5E5EBQTFSJFT
r 5EBQTIPVMECFTVCTUJUVUFEGPSBTJOHMFEPTFPG5EJOUIFDBUDIVQTFSJFTPSBTB
CPPTUFSGPSDIJMESFOBHFEUISPVHIZFBSTVTF5EGPSPUIFSEPTFT
11. Human papillomavirus vaccine (HPV).
r "ENJOJTUFS UIF TFSJFT UP GFNBMFT BU BHF UISPVHI ZFBST JG OPU QSFWJPVTMZ
vaccinated.
r 6TFSFDPNNFOEFESPVUJOFEPTJOHJOUFSWBMTGPSTFSJFTDBUDIVQJFUIFTFDPOEBOE
third doses should be administered at 1 to 2 and 6 months after the first dose). The
NJOJNVNJOUFSWBMCFUXFFOUIFàSTUBOETFDPOEEPTFTJTXFFLT5IFNJOJNVN
JOUFSWBMCFUXFFOUIFTFDPOEBOEUIJSEEPTFTJTXFFLTBOEUIFUIJSEEPTFTIPVME
CFBENJOJTUFSFEBUMFBTUXFFLTBGUFSUIFàSTUEPTF
Information about reporting reactions after immunization is available online at http://www.vaers.hhs.gov or by telephone, 800-822-7967.4VTQFDUFEDBTFTPGWBDDJOFQSFWFOUBCMFEJTFBTFTTIPVMECFSFQPSUFEUPUIFTUBUF
or local health department. Additional information, including precautions and contraindications for immunization, is available from the National Center for Immunization and Respiratory Diseases at http://www.cdc.gov/
vaccines or telephone, 800-CDC-INFO
%FQBSUNFOUPG)FBMUIBOE)VNBO4FSWJDFTr$FOUFSTGPS%JTFBTF$POUSPMBOE1SFWFOUJPO
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CHILDREN’S SERVICES HANDBOOK
B.3 General Recommendations
For information about vaccine administration, dosing, and contraindications, immunization providers
should consult vaccine package inserts and the December 1, 2006, issue of the Morbidity and Mortality
Weekly Report (MMWR), General Recommendations on Immunization, Recommendations of the
Advisory Committee on Immunization Practices. For copies of the General Recommendations on
Immunization or the MMWR, contact the Immunization Branch at 1-512-458-7284.
B.3.1 How to Obtain Free Vaccines
TVFC provides routinely recommended ACIP vaccines for immunization of THSteps and other
Medicaid-eligible clients free of charge to providers who are enrolled in TVFC. The local health
department/district or DSHS regional office provides information on how to order, account for, and
inventory vaccines. Monthly reports are required in order to receive state-purchased vaccines. Physicians who request and accept state-supplied vaccines must complete and sign the provider enrollment
and profile forms annually. The provider may not charge Medicaid or the client for vaccines obtained
from TVFC.
Additional information can be found at www.immunizetexas.com.
B.3.2 Administrations and Immunizations
The following administration procedure codes must be submitted in combination with an appropriate
vaccine/toxoid procedure code. Diagnosis procedure code V202 may be used unless a more specific
diagnosis code is appropriate:
Administration Procedure Codes
90465
90466
90473
90474
90467
90468
90471
90472
Vaccine/toxoid administration fee for clients birth through 20 years of age will be reimbursed based on
the number of state-defined components administered per injection and may or may not require the use
of one of the following modifiers. Combined antigen vaccines (e.g., DTaP or MMR) are considered as
one dose. The provider may not charge in excess of $14.85 for administration of vaccines to a TVFCeligible client.
Modifier
Description
U2
State-defined modifier: Administration of vaccine/toxoid with two state defined
components
U3
State-defined modifier: Administration of vaccine/toxoid with three state
defined components
B.3.2.1 Vaccine Procedure Codes and State-Defined Components
The following vaccines are defined as having one state-defined component and the administrative
procedure code do not require a modifier.
Vaccine Procedure Codes
90632*
90633*
90645
90646
90647
90648*
90649*
90655*
90656*
90657*
90658*
90660*
90669*
90680*
90681
90700*
90702*
90703
90704
90705
90706
90707*
90713*
90714*
* TVFC distributed vaccine/toxoid.
Note: Vaccines that are not identified as being distributed through TVFC are not reimbursed separately.
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TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 2
Vaccine Procedure Codes
90716*
90718
90732*
90733
90734*
90743
90744*
90746*
90747
90749
90740*
* TVFC distributed vaccine/toxoid.
Note: Vaccines that are not identified as being distributed through TVFC are not reimbursed separately.
The following vaccines are defined as having two state-defined components and the administrative
procedure code must be billed with the state-defined modifier U2.
Vaccine Procedure Codes
90636
90696
90710*
90715*
90721
90748*
* TVFC distributed vaccine/toxoid.
Note: Vaccines that are not identified as being distributed through TVFC are not reimbursed separately.
The following vaccines are defined as having three state-defined components and the administrative
procedure code must be billed with the state-defined modifier U3.
Vaccine Procedure Codes
90698*
90723*
* TVFC distributed vaccine/toxoid.
Providers may use the state-defined modifier U1 in addition to the associated administered vaccine
procedure code for clients birth through 18 years of age and the vaccine was unavailable through TVFC.
Modifier
Description
U1
State-defined modifier: Vaccine(s)/toxoid(s) privately purchased by provider
when TVFC vaccine/toxoid is unavailable
Note: “Unavailable” is defined as a new vaccine approved by the Advisory Committee on Immunization Practices (ACIP) that has not been negotiated or added to a TVFC contract, funding
for new vaccine that has not been established by TVFC, or national supply or distribution
issues.
Modifier U1 may not be used for failure to enroll in TVFC, maintain sufficient TVFC vaccine/toxoid
inventory or clients who are 19 years of age through 20 years of age.
B.3.3 Requirements for TVFC Providers
By enrolling, public and private providers agree to:
• Screen patients for TVFC eligibility at all immunization encounters, and administer TVFCpurchased vaccines only to clients 18 years of age or younger who meet one or more of the following
criteria:
• Is an American Indian or Alaska Native.
• Is enrolled in Medicaid.
• Has no health insurance.
• Is underinsured.
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CHILDREN’S SERVICES HANDBOOK
• Clients who have other health insurance, but the coverage does not include vaccines, clients
whose insurance covers only selected vaccines (TVFC-eligible for non-covered vaccines only),
clients whose insurance caps vaccine coverage at a certain amount (once that coverage amount
is reached, these clients are categorized as underinsured), or has insurance with a co-pay or
deductible the family cannot meet.
• Is a client who receives benefits from the Children’s Health Insurance Program (CHIP).
• Is a client who is served by any type of public health clinic and does not meet any of the above
criteria.
• Maintain all records related to the TVFC program, including parent/guardian/authorized representative’s responses on the Patient Eligibility Screening Form for at least three years. If requested, the
provider will make such records available to DSHS, the local health department authority, or the
U.S. Department of Health and Human Services (HHS).
• Comply with the appropriate vaccination schedule, dosage, and contraindications, as established by
ACIP, unless (a) in making a medical judgment in accordance with accepted medical practice, the
provider deems such compliance to be medically inappropriate, or (b) the particular requirement is
not in compliance with Texas law, including laws relating to religious and medical exemptions.
• Provide VISs to the responsible adult, parent, or guardian, and maintain records in accordance with
the NCVIA which include reporting clinically significant adverse events to VAERS. Signatures are
required for informed consent. (The Texas Addendum portion of the VIS may be used to document
informed consent.)
• Not charge for vaccines supplied by DSHS and administered to a client who is eligible for TVFC.
• Charge a vaccine administration fee to Texas Medicaid but not impose a charge for the administration of the vaccine in any amount higher than the maximum administration fee established by
DSHS (providers may charge a vaccine administration fee to Medicaid, but not a fee for the vaccine).
Medicaid clients cannot be charged any out-of-pocket expense for the vaccine, administration of the
vaccine, or an office visit associated with Medicaid services.
• Not deny administration of a TVFC vaccine to a client because of the inability of the client’s parent
or guardian/individual of record to pay an administrative fee.
• Comply with the state’s requirements for ordering vaccines and other requirements as described by
DSHS, and operate within the TVFC program in a manner intended to avoid fraud and abuse.
• Allow DSHS (or its contractors) to conduct onsite visits as required by TVFC regulations.
The provider or the state may terminate the agreement at any time for failure to comply with the requirements listed above. If the agreement is terminated for any reason, the provider agrees to properly return
any unused vaccine.
B.3.4 How to Report Immunization Records to ImmTrac, the Texas
Immunization Registry
Texas law requires all medical providers and payors to report all immunizations administered to clients
17 years of age or younger, to ImmTrac, the Texas immunization registry operated by DSHS (Texas
Health and Safety Code §§161.007-161.009). Providers must report all immunization information
within 30 days of administration of the vaccine, and payors must report within 30 days of receipt of data
elements from a provider. Prior to reporting immunizations to ImmTrac, providers must first register
for registry participation and access.
ImmTrac is a centralized repository of immunization histories for clients 17 years of age or younger and
is a free service and benefit available to all Texans. Registry information is confidential, and by law, may
be released only to:
• The client’s parent, legal guardian, or managing conservator.
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• The client’s physician, school, or licensed child-care facility in which the client is enrolled.
• Public health districts or local health departments.
• The insurance company, health maintenance organization, or other organization that pays for the
provision of the client’s health-care benefits.
• A health-care provider authorized to administer a vaccine.
• A state agency that has legal custody of the client.
ImmTrac offers two methods for reporting immunizations to DSHS: direct internet entry into
ImmTrac’s internet application and electronic data transfer (import).
B.3.4.1 Direct Internet Entry
This method allows providers to access and review clients’ immunization histories prior to administering vaccines. Providers then update their client’s immunization record directly into the ImmTrac web
application after administering vaccines to the patient.
B.3.4.2 Electronic Data Transfer (Import)
This method allows providers to report immunizations from an electronic medical record (EMR)
software application via extract file for import into ImmTrac. Providers may still have access to the
ImmTrac web application to access and review their clients’ immunization histories before administering any vaccines.
Regardless of reporting option selected, all providers must first register for ImmTrac access and receive
login credentials from ImmTrac Customer Support. To register for ImmTrac access, providers may
obtain and complete an ImmTrac Registration Packet (for providers and schools) from
www.immtrac.com or request it from ImmTrac Customer Support at 1-800-348-9158.
B.3.4.3 Obtaining Parental Consent for Registry Participation
Before including a client’s immunization information in ImmTrac, DSHS must verify that written
consent for registry participation has been granted by the client’s parent, legal guardian, or managing
conservator. Most parents grant consent for ImmTrac participation during the birth certificate registration process. Written parental consent for ImmTrac participation applies to all past, present, and
future immunizations. Texas law also permits a parent, managing conservator, or guardian to withdraw
consent for ImmTrac participation at any time.
Providers may offer parents the opportunity to grant consent for their child’s participation in ImmTrac
using the pre-filled, ImmTrac-generated Immunization Registry (ImmTrac) Consent Form or the
manual version (#C-7) of this form, also available from the ImmTrac application. Providers should
retain the consent form and affirm parental consent via ImmTrac to establish the client’s ImmTrac
record and report all immunizations administered and/or add any historical immunization information
to the client’s record. Entering administered immunizations and/or historical immunization information to the client’s record constitutes “reporting” to ImmTrac as required by current Texas law.
B.4 Texas Vaccines for Children Program Packet
Refer to: Form CH.27, “TVFC Patient Eligibility Screening Record” in Appendix A, THSteps Forms,
of this handbook.
Form CH.29, “TVFC Provider Enrollment (3 Pages)” in Appendix A, THSteps Forms, of
this handbook.
Form CH.30, “TVFC Questions and Answers (3 Pages)” in Appendix A, THSteps Forms,
of this handbook.
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