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H1N1 Influenza Virus Pre-Registraton

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Maryland H1N1 (Swine) Flu Response

 

H1N1 (Swine) Flu

Pre-Register Now to Administer Vaccine in Maryland

The Maryland Department of Health and Mental Hygiene (DHMH) requests interested vaccine providers to signup to receive H1N1 influenza vaccine. DHMH has established a pre-registration process for immunization providers to identify their facilities as possible vaccine administration sites for the 2009 novel H1N1 influenza vaccine. Pre-registration with DHMH is the only way to receive H1N1 influenza vaccine. 
 
H1N1 vaccine is being purchased by the federal government and will be made available and shipped to pre-registered sites at no charge. Syringes, needles, sharps containers, and alcohol swabs will also be provided at no charge. Current estimates are that the vaccine will be ready for distribution mid-October (this date is subject to change). Pre-registered sites are not committed to administering vaccine, however they will receive periodic updates and vaccine planning information. Prior to receiving vaccine, your site will need to complete a Provider Agreement that outlines the specific terms and conditions of vaccine use and accountability as defined by federal and state authorities.
 
Sites that may wish to pre-register include healthcare provider offices, schools, and other private settings, such as community vaccinators, pharmacies and workplaces.  Facilities with multiple locations should submit a separate pre-registration form for each vaccination site.  

Please contact the Center for Immunization at H1N1Info@dhmh.state.md.us  if your business has centralized distribution for multiple sites and would like to discuss pre-registering as one site.  Please ensure that information is provided on the authorized prescriber (e.g., M.D., D.O.) under whose authority vaccinations will be administered at your site. 

 

 

Please Review the Pre-Registration Definitions prior to Completing the Survey

Click Here for Definitions for H1N1 Pre-Registration Terms This is a .PDF document.  Adobe Acrobat Reader download version 4.0 or higher is required to view PDF files.

Click Here for Pre-Registration Sign-up for H1N1 Influenza Vaccine Administration Sites

 


Next Steps

The following forms will ultimately need to be submitted before vaccine is shipped to your site, likely sometime in mid-September.  Some of these documents are not yet available but we wanted to make you aware of the next steps in the process. These forms will be emailed or faxed to the H1N1 Point of Contact for completion.

  • H1N1 Provider Agreement for vaccine use and accountability

  • H1N1 Vaccine Order Form

Vaccine Accountability

Guidance on the tracking and submission of doses administered data will be emailed or faxed to the H1N1 Point of Contact.

For Questions or Concerns Email:

Maryland Center for Immunization

H1N1Info@dhmh.state.md.us

Resources for Additional Information:

CDC H1N1 Flu (Swine Flu): General Information

 


 

Portable Document Format (..pdf)

acrobat readerSome of the documents published are in .pdf format. The free viewer can be downloaded here.

Office of Governor

Related Information

  • About Swine Influenza (Flu)
  • Things you can do
  • Recommendations for Parents and Caregivers
  • Recommendations for Health Care Providers
  • Interim Recommendations for Facemask and Respirator Use in Certain Community Settings
  • Plan & Prepare - Pandemic Home
  • International Information
  • Maryland Epidemiological Information
  • Be a Flu Fighter

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