**HIGH PRIORITY QUESTION KEY**

All questions indicated with the **!** icon are considered high priority
questions. Inappropriate or incorrect responses given to any of these
questions require that a corrective action plan be developed with the
provider by the staff person conducting the VFC site visit. The newly
added "pre-visit" review question was added to incorporate a review of
the provider profile related to the provider's vaccine ordering patterns
to identify issues that may need further follow-up. If a reviewer is
unable to identify a valid reason for the ordering discrepancy then the
situation should be documented as a potential case of fraud and abuse
and followed-up based on the grantee's fraud and abuse policy. The table
below is to be used as a key. It outlines the correct response to each
of the high risk questions.

+---+----------------+---------------+--------+----------------------+
| * | **Question**   | **Response    | **     | **Unacceptable-      |
| * |                | Options**     | Accept | Requires Corrective  |
| \ |                |               | able** | Action in #32**      |
| # |                |               |        |                      |
| * |                |               |        |                      |
| * |                |               |        |                      |
+---+----------------+---------------+--------+----------------------+
| * | Are vaccine    | 1.  Yes       | Yes    | No. Conduct further  |
| * | orders         |               |        | review/research to   |
| P | consistent     | 2.  No        |        | determine if the     |
| r | with most      |               |        | provider's patient   |
| e | current        |               |        | population           |
| - | provider       |               |        | significantly        |
| v | profile?       |               |        | changed in size but  |
| i |                |               |        | the provider profile |
| s |                |               |        | was not updated. If  |
| i |                |               |        | this is the case, an |
| t |                |               |        | updated provider     |
| * |                |               |        | profile must be      |
| * |                |               |        | submitted to the     |
|   |                |               |        | immunization program |
| * |                |               |        | as soon as possible. |
| * |                |               |        | The VFC staff should |
| R |                |               |        | follow-up to make    |
| e |                |               |        | sure the revised     |
| v |                |               |        | provider profile is  |
| i |                |               |        | submitted.           |
| e |                |               |        |                      |
| w |                |               |        | If no reason can be  |
| * |                |               |        | identified for       |
| * |                |               |        | vaccine orders that  |
|   |                |               |        | are greater than     |
|   |                |               |        | expected based on    |
|   |                |               |        | the current provider |
|   |                |               |        | profile, the         |
|   |                |               |        | situation should be  |
|   |                |               |        | documented as a      |
|   |                |               |        | potential case of    |
|   |                |               |        | fraud and abuse and, |
|   |                |               |        | following the        |
|   |                |               |        | grantee's written    |
|   |                |               |        | policy, be referred  |
|   |                |               |        | for further          |
|   |                |               |        | investigation or     |
|   |                |               |        | education.           |
+---+----------------+---------------+--------+----------------------+
| * | What is the    | Open-ended    | Within | In excess of state   |
| * | vaccine        |               | state  | cap. \*\* Universal  |
| 1 | administration |               | cap    | states may set their |
| * | fee charged to |               | (      | administration fee   |
| * | non-Medicaid   |               | varies | for the non-Medicaid |
|   | VFC eligible   |               | by     | VFC eligible         |
|   | patients       |               | state) | children higher than |
|   | (uninsured,    |               |        | the listed maximum   |
|   | American       |               |        | regional charge      |
|   | Indian/Alaska  |               |        | **but only if** the  |
|   | Native,        |               |        | proper protocol was  |
|   | under-insured  |               |        | followed and         |
|   | if vaccinated  |               |        | documented. The      |
|   | at FQHC/RHC)?  |               |        | protocol that must   |
|   |                |               |        | be followed is       |
|   |                |               |        | outlined in the      |
|   |                |               |        | Federal Register,    |
|   |                |               |        | Vol 59, No.190,      |
|   |                |               |        | October 3, 1994      |
+---+----------------+---------------+--------+----------------------+

+---+----------------+---------------+--------+----------------------+
| * | **Question**   | **Response    | **     | **U                  |
| * |                | Options**     | Accept | nacceptable-requires |
| \ |                |               | able** | a corrective action  |
| # |                |               |        | plan be developed in |
| * |                |               |        | #32**                |
| * |                |               |        |                      |
+---+----------------+---------------+--------+----------------------+
| * | When does this | 1.  Every     | Option | Option 2-4           |
| * | c              |     time the  | 1      |                      |
| 4 | linic/practice |     patient   |        |                      |
| * | provide        |     receives  |        |                      |
| * | patients with  |     a         |        |                      |
|   | copies of the  |               |        |                      |
|   | Vaccine        |   vaccination |        |                      |
|   | Information    |               |        |                      |
|   | Statements     | 2.  When the  |        |                      |
|   | (VIS) to keep? |     child     |        |                      |
|   |                |     receives  |        |                      |
|   |                |     the first |        |                      |
|   |                |     dose of   |        |                      |
|   |                |     vaccine   |        |                      |
|   |                |     within a  |        |                      |
|   |                |               |        |                      |
|   |                |    particular |        |                      |
|   |                |     series    |        |                      |
|   |                |     (e.g.     |        |                      |
|   |                |     1^st^     |        |                      |
|   |                |     dose of   |        |                      |
|   |                |     DTaP)     |        |                      |
|   |                |               |        |                      |
|   |                | 3.  Do not    |        |                      |
|   |                |     provide   |        |                      |
|   |                |               |        |                      |
|   |                | 4.  Other     |        |                      |
|   |                |     (specify) |        |                      |
+---+----------------+---------------+--------+----------------------+
| * | When does the  | 1.  First     | >      | > Option 1, 3, , 5   |
| * | c              |               | Option |                      |
| 6 | linic/practice |  immunization | > 2,4  |                      |
| * | screen         |     visit to  |        |                      |
| * | patients for   |     the       |        |                      |
|   | VFC            |     office    |        |                      |
|   | eligibility?   |               |        |                      |
|   |                | 2.  Every     |        |                      |
|   |                |               |        |                      |
|   |                |  immunization |        |                      |
|   |                |     visit     |        |                      |
|   |                |               |        |                      |
|   |                | 3.  Do not    |        |                      |
|   |                |     screen    |        |                      |
|   |                |     for VFC   |        |                      |
|   |                |               |        |                      |
|   |                |   eligibility |        |                      |
|   |                |               |        |                      |
|   |                | 4.  Not       |        |                      |
|   |                |               |        |                      |
|   |                |    Applicable |        |                      |
|   |                |     clinic    |        |                      |
|   |                |     /practice |        |                      |
|   |                |     serves    |        |                      |
|   |                |     100% VFC  |        |                      |
|   |                |     eligible  |        |                      |
|   |                |     children  |        |                      |
|   |                |     and has   |        |                      |
|   |                |     the       |        |                      |
|   |                |               |        |                      |
|   |                |   appropriate |        |                      |
|   |                |               |        |                      |
|   |                | Comprehensive |        |                      |
|   |                |               |        |                      |
|   |                |   Certificate |        |                      |
|   |                |     with up   |        |                      |
|   |                |     to date   |        |                      |
|   |                |     signature |        |                      |
|   |                |     on file.  |        |                      |
|   |                |               |        |                      |
|   |                | 5.  Other     |        |                      |
|   |                |     (specify) |        |                      |
+---+----------------+---------------+--------+----------------------+
| * | Does this      | 1.  Yes       | >      | > Option 2           |
| * | c              |               | Option |                      |
| 7 | linic/practice | 2.  No        | > 1    |                      |
| * | always notify  |               |        |                      |
| * | the            |               |        |                      |
|   | immunization   |               |        |                      |
|   | program when   |               |        |                      |
|   | publicly       |               |        |                      |
|   | purchased      |               |        |                      |
|   | vaccine has    |               |        |                      |
|   | been involved  |               |        |                      |
|   | in a cold      |               |        |                      |
|   | chain failure, |               |        |                      |
|   | has expired or |               |        |                      |
|   | been wasted?   |               |        |                      |
+---+----------------+---------------+--------+----------------------+
| * | When does the  | 1.            | >      | > Option 2           |
| * | c              |   Immediately | Option |                      |
| 8 | linic/practice |     before    | > 1    |                      |
| * | prepare        |     a         |        |                      |
| * | vaccine for    | dministration |        |                      |
|   | administration |               |        |                      |
|   | to patients?   | 2.  Other:    |        |                      |
|   |                |     specify   |        |                      |
+---+----------------+---------------+--------+----------------------+

+---+----------------+---------------+--------+----------------------+
| * | **Question**   | **Response    | **     | **Unacceptable-      |
| * |                | Options**     | Accept | Requires Corrective  |
| \ |                |               | able** | Action in #32**      |
| # |                |               |        |                      |
| * |                |               |        |                      |
| * |                |               |        |                      |
+---+----------------+---------------+--------+----------------------+
| * | Does the       | 1.  Yes       | >      | > No to all 8        |
| * | c              |               | Option | > components or any  |
| 9 | linic/practice | 2.  No        | >      | > combination of Yes |
| * | have a written |               |  1-Yes | > and No answer to   |
| * | plan for       |               |        | > the components     |
|   | vaccine        |               | All 8  |                      |
|   | management?    |               | comp   | Any component with a |
|   | (ask to see a  |               | onents | "No" response        |
|   | copy)          |               | must   | selected must have a |
|   |                |               | be     | corrective action    |
|   |                |               | p      | plan developed with  |
|   |                |               | resent | the provider by the  |
|   |                |               | and    | staff person         |
|   |                |               | c      | conducting the VFC   |
|   |                |               | ontent | site visit for that  |
|   |                |               | must   | specific component   |
|   |                |               | accu   |                      |
|   |                |               | rately |                      |
|   |                |               | r      |                      |
|   |                |               | eflect |                      |
|   |                |               | requir |                      |
|   |                |               | ements |                      |
|   |                |               | in     |                      |
|   |                |               | Module |                      |
|   |                |               | 6 of   |                      |
|   |                |               | VFC    |                      |
|   |                |               | Oper   |                      |
|   |                |               | ations |                      |
|   |                |               | Guide( |                      |
|   |                |               | August |                      |
|   |                |               | 2007   |                      |
|   |                |               | re     |                      |
|   |                |               | lease) |                      |
+---+----------------+---------------+--------+----------------------+
| * | Please         | 1\. Current   | > O    | > Options 2 or 3 to  |
| * | identify the   |               | ptions | > any VIS for a VFC  |
| 1 | publication    | 2\. Outdated  | > 1 or | > vaccine provided   |
| 0 | date for each  |               | > 4    | > within the         |
| * | VIS currently  | 3\. None Used |        | > practice.          |
| * | being used in  |               |        | >                    |
|   | this           | 4\. Does not  |        | > **Please note: The |
|   | c              | administer    |        | > VIS dates listed   |
|   | linic/practice |               |        | > in Question 10     |
|   | and then check |               |        | > were current at    |
|   | the            |               |        | > the time the word  |
|   | appropriate    |               |        | > version of the     |
|   | status for     |               |        | > questionnaire was  |
|   | each VIS       |               |        | > provided to the    |
|   |                |               |        | > grantees. VIS are  |
|   |                |               |        | > updated on an      |
|   |                |               |        | > as-needed basis so |
|   |                |               |        | > each grantee must  |
|   |                |               |        | > develop a process  |
|   |                |               |        | > to check for new   |
|   |                |               |        | > VIS form dates     |
|   |                |               |        | > between the annual |
|   |                |               |        | > release of the VFC |
|   |                |               |        | > site visit         |
|   |                |               |        | > questionnaire**    |
+---+----------------+---------------+--------+----------------------+
| * | What type of   | 1.            | >      | > Option,2, 3, 5     |
| * | storage units  |   Stand-alone | Option |                      |
| 1 | does this      |     freezer   | > 1,4, |                      |
| 1 | c              |               | > 6    |                      |
| * | linic/practice | 2.            |        |                      |
| * | use to store   |  Stand--alone |        |                      |
|   | varice         |               |        |                      |
|   | lla-containing |  refrigerator |        |                      |
|   | vaccine?       |               |        |                      |
|   |                | 3.  Dormitory |        |                      |
|   |                |     style     |        |                      |
|   |                |     refrige   |        |                      |
|   |                | rator/freezer |        |                      |
|   |                |               |        |                      |
|   |                | 4.  Combined  |        |                      |
|   |                |     refrige   |        |                      |
|   |                | rator/freezer |        |                      |
|   |                |     with      |        |                      |
|   |                |     separate  |        |                      |
|   |                |     external  |        |                      |
|   |                |               |        |                      |
|   |                |  refrigerator |        |                      |
|   |                |     and       |        |                      |
|   |                |     freezer   |        |                      |
|   |                |     doors     |        |                      |
|   |                |     (e.g.     |        |                      |
|   |                |     ho        |        |                      |
|   |                | usehold-style |        |                      |
|   |                |               |        |                      |
|   |                |    appliance) |        |                      |
|   |                |               |        |                      |
|   |                | 5.  Combined  |        |                      |
|   |                |     refrige   |        |                      |
|   |                | rator/freezer |        |                      |
|   |                |     with a    |        |                      |
|   |                |     single    |        |                      |
|   |                |     door      |        |                      |
|   |                |               |        |                      |
|   |                | 6\. Does not  |        |                      |
|   |                | administer    |        |                      |
|   |                | vaccines      |        |                      |
|   |                | requiring     |        |                      |
|   |                | freezer       |        |                      |
|   |                | storage       |        |                      |
+---+----------------+---------------+--------+----------------------+

+---+----------------+---------------+--------+----------------------+
| * | **Question**   | **Response    | > **   | > **U                |
| * |                | Options**     | Accept | nacceptable-Requires |
| \ |                |               | able** | > Corrective Action  |
| # |                |               |        | > in #32**           |
| * |                |               |        |                      |
| * |                |               |        |                      |
+---+----------------+---------------+--------+----------------------+
| * | What type of   | 1.  Stand     | > **Op | > **Options: 1, 3,   |
| * | refrigeration  |     alone     | tions: | > 5**                |
| 1 | unit is used   |     freezer   | > 2,   |                      |
| 1 | to store all   |               | > 4**  |                      |
| * | other vaccines | 2.            |        |                      |
| * | (except        |   Stand-alone |        |                      |
|   | varicella      |               |        |                      |
|   | containing)?   |  refrigerator |        |                      |
|   | (check all     |               |        |                      |
|   | that apply)    | 3.  Dormitory |        |                      |
|   |                |     style     |        |                      |
|   |                |     refrige   |        |                      |
|   |                | rator/freezer |        |                      |
|   |                |               |        |                      |
|   |                | 4.  Combined  |        |                      |
|   |                |     refrige   |        |                      |
|   |                | rator/freezer |        |                      |
|   |                |     with      |        |                      |
|   |                |     separate  |        |                      |
|   |                |     external  |        |                      |
|   |                |               |        |                      |
|   |                |  refrigerator |        |                      |
|   |                |     and       |        |                      |
|   |                |     freezer   |        |                      |
|   |                |     doors     |        |                      |
|   |                |     (e.g.     |        |                      |
|   |                |     ho        |        |                      |
|   |                | usehold-style |        |                      |
|   |                |               |        |                      |
|   |                |    appliance) |        |                      |
|   |                |               |        |                      |
|   |                | 5.  Combined  |        |                      |
|   |                |     refrige   |        |                      |
|   |                | rator/freezer |        |                      |
|   |                |     with      |        |                      |
|   |                |     single    |        |                      |
|   |                |     door      |        |                      |
|   |                |     (e.g.     |        |                      |
|   |                |     ho        |        |                      |
|   |                | usehold-style |        |                      |
|   |                |               |        |                      |
|   |                |    appliance) |        |                      |
+---+----------------+---------------+--------+----------------------+
| * | Are working    | 1.  Yes       | >      | > Options 2, 3       |
| * | thermometers   |               | Option |                      |
| 1 | placed in a    | 2.  Have      | > 1    | [Use of multiple     |
| 2 | central area   |               |        | thermo               |
| * | of each        |   thermometer |        | meters]{.underline}: |
| * | refrigerator   |     but not   |        | Although multiple    |
|   | and freezer?   |     placed    |        | thermometers are not |
|   |                |     properly  |        | required within a    |
|   | See note in    |               |        | storage unit, it is  |
|   | right column.  | 3.  No        |        | recognized that some |
|   |                |               |        | providers may wish   |
|   |                |   thermometer |        | to thoroughly        |
|   |                |               |        | monitor temperatures |
|   |                |               |        | throughout their     |
|   |                |               |        | storage unit. When a |
|   |                |               |        | site is using        |
|   |                |               |        | multiple             |
|   |                |               |        | thermometers, it is  |
|   |                |               |        | important that they  |
|   |                |               |        | select only one      |
|   |                |               |        | certified and        |
|   |                |               |        | centrally-located    |
|   |                |               |        | thermometer as their |
|   |                |               |        | official recorder of |
|   |                |               |        | temperatures.        |
+---+----------------+---------------+--------+----------------------+
| * | For each type  | 1.  Yes       | >      | > Option 2- If "No"  |
| * | of thermometer |               | Option | > is selected for    |
| 1 | used by the    | 2.  No        | > 1-   | > any of the storage |
| 3 | practice,      |               | > Yes  | > units, a           |
| b | indicate if    |               |        | > corrective action  |
| * | the            |               |        | > plan must be       |
| * | thermometer is |               |        | > developed even if  |
|   | certified      |               |        | > only one unit does |
|   | (check all     |               |        | > not have a         |
|   | that apply)?   |               |        | > certified          |
|   | Refer to 13(A) |               |        | > thermometer. If    |
|   | for type of    |               |        | > any units have     |
|   | thermometer    |               |        | > both certified and |
|   |                |               |        | > uncertified        |
|   |                |               |        | > thermometers       |
|   |                |               |        | > located in the     |
|   |                |               |        | > unit, the staff    |
|   |                |               |        | > must be instructed |
|   |                |               |        | > to use only the    |
|   |                |               |        | > certified          |
|   |                |               |        | > thermometer to     |
|   |                |               |        | > record the         |
|   |                |               |        | > temperature on the |
|   |                |               |        | > log sheets.        |
+---+----------------+---------------+--------+----------------------+
| * | **Question**   | **Response    | > **   | > **U                |
| * |                | Options**     | Accept | nacceptable-Requires |
| \ |                |               | able** | > Corrective Action  |
| # |                |               |        | > in #32**           |
| * |                |               |        |                      |
| * |                |               |        |                      |
+---+----------------+---------------+--------+----------------------+
| * | For each       | 1.  Once a    | > O    | > Options 1, 2       |
| * | refrigerator   |     day       | ptions | > specify in         |
| 1 | and freezer    |               | > 3, 4 | > corrective action  |
| 4 | indicate how   | 2.  Less than |        | > section (#32)      |
| * | often          |     once a    |        | >                    |
| * | temperatures   |     day       |        | > If Option 4 is     |
|   | are recorded   |               |        | > selected if the    |
|   | (check all     | 3.  Twice a   |        | > practice monitors  |
|   | that apply)    |     day       |        | > the temperatures   |
|   |                |               |        | > more than twice a  |
|   |                | 4.  More than |        | > day. It is         |
|   |                |     twice a   |        | > important to       |
|   |                |     day       |        | > acknowledge to the |
|   |                |               |        | > office that the    |
|   |                |               |        | > VFC program        |
|   |                |               |        | > appreciates their  |
|   |                |               |        | > diligence, but it  |
|   |                |               |        | > is not necessary   |
|   |                |               |        | > to monitor the     |
|   |                |               |        | > temperatures more  |
|   |                |               |        | > than twice a day   |
|   |                |               |        | > (a.m. & p.m.) and  |
|   |                |               |        | > discuss with the   |
|   |                |               |        | > practice staff how |
|   |                |               |        | > that time could be |
|   |                |               |        | > used to improve    |
|   |                |               |        | > another aspect of  |
|   |                |               |        | > vaccine management |
|   |                |               |        | > & document         |
|   |                |               |        | > corrective action  |
|   |                |               |        | > section..          |
+---+----------------+---------------+--------+----------------------+
| * | During past 3  | Number of     | > 0 or | > Anything greater   |
| * | months, how    | occurrences   | >      | > than 0             |
| 1 | many times     |               |  blank | >                    |
| 6 | were the       |               |        | > Review responses   |
| * | temperatures   |               |        | > to question \# 17  |
| * | outside the    |               |        | > and #18 to         |
|   | recommended    |               |        | > determine if all   |
|   | range?         |               |        | > necessary actions  |
|   |                |               |        | > were taken when    |
|   |                |               |        | > the temperature    |
|   |                |               |        | > was identified as  |
|   |                |               |        | > outside the        |
|   |                |               |        | > recommended range  |
|   |                |               |        | > and actions were   |
|   |                |               |        | > documented.        |
+---+----------------+---------------+--------+----------------------+

+------+----------------+--------------+--------+---------------------+
| **   | **Question**   | **Response   | **     | **Unacceptable-     |
| \#** |                | Options**    | Accept | Requires Corrective |
|      |                |              | able** | Action in #32**     |
+------+----------------+--------------+--------+---------------------+
| **   | When           | 1.  Adjust   | > O    | > Option 6 or       |
| 17** | temperatures   |              | ptions | > selecting only 1  |
|      | were outside   |   thermostat | > 1-5  | > or 2 of the       |
| **   | the range,     |     in       | >      | > acceptable        |
| Only | what action(s) |              | > Dep  | > options when the  |
| if   | did the        | refrigerator | ending | > situation         |
| o    | c              |     /freezer | > on   | > required further  |
| ut-- | linic/practice |              | > situ | > action to         |
| of-r | take?          | 2.  Measure  | ation, | > safeguard or      |
| ange |                |              | > the  | > determine the     |
| temp |                |  temperature | > most | > viability of the  |
| has  |                |     with     | > acce | > vaccine.          |
| been |                |              | ptable | >                   |
| docu |                |    different | >      | > **Reviewers must  |
| ment |                |              | answer | > use their         |
| ed** |                |  thermometer | > may  | > judgment to       |
|      |                |     to check | > be a | > decide if all     |
|      |                |     accuracy | >      | > necessary steps   |
|      |                |     of       |  combi | > were taken for    |
|      |                |     original | nation | > identified        |
|      |                |     reading  | > of   | > situation.**      |
|      |                |              | > o    |                     |
|      |                | 3.  Moved    | ptions |                     |
|      |                |     vaccine  | > or   |                     |
|      |                |     to a     | > sel  |                     |
|      |                |              | ecting |                     |
|      |                |    different | > all  |                     |
|      |                |     refriger | > o    |                     |
|      |                | ator/freezer | ptions |                     |
|      |                |              | > 1-5  |                     |
|      |                | 4.  Called   |        |                     |
|      |                |     the      |        |                     |
|      |                |     vaccine  |        |                     |
|      |                |              |        |                     |
|      |                | manufacturer |        |                     |
|      |                |     to       |        |                     |
|      |                |              |        |                     |
|      |                |    determine |        |                     |
|      |                |     potency  |        |                     |
|      |                |     of the   |        |                     |
|      |                |     vaccine  |        |                     |
|      |                |              |        |                     |
|      |                | 5.  Called   |        |                     |
|      |                |     the      |        |                     |
|      |                |              |        |                     |
|      |                |  local/state |        |                     |
|      |                |              |        |                     |
|      |                | immunization |        |                     |
|      |                |     program  |        |                     |
|      |                |     for      |        |                     |
|      |                |              |        |                     |
|      |                |   assistance |        |                     |
|      |                |              |        |                     |
|      |                | 6.  Did not  |        |                     |
|      |                |     do       |        |                     |
|      |                |     anything |        |                     |
+------+----------------+--------------+--------+---------------------+
| **   | Does the       | 1.  Yes      | >      | > Option 2- No      |
| 18** | c              |              | Option | >                   |
|      | linic/practice | 2.  No       | > 1-   | > All actions must  |
| **   | have written   |              | > Yes  | > be documented on  |
| Only | documentation  |              |        | > the back of       |
| if   | of action      |              |        | > temperature log   |
| o    | taken when the |              |        | > or on a separate  |
| ut-- | temperatures   |              |        | > page attached to  |
| of-r | were outside   |              |        | > log with the date |
| ange | the            |              |        | > that the          |
| temp | recommended    |              |        | > temperature was   |
| has  | range?         |              |        | > out of range.     |
| been |                |              |        |                     |
| docu |                |              |        |                     |
| ment |                |              |        |                     |
| ed** |                |              |        |                     |
+------+----------------+--------------+--------+---------------------+
| **   | Are current    | 1\. Yes      | >      | > Option 2-No- to   |
| 20** | temperatures   |              | Option | > any unit          |
|      | within the     | 2\. No       | >      | >                   |
|      | guidelines     |              |  1-Yes | > If any unit is    |
|      | according to   |              | > to   | > out of            |
|      | the reviewer's |              | > all  | > temperature       |
|      | thermometer?   |              | >      | > range, the        |
|      | (Refrigerator: |              |  units | > reviewer must     |
|      | 2-8°C /        |              |        | > assist /instruct  |
|      | 35-46°F,       |              |        | > the staff on the  |
|      | Freezer: -15°C |              |        | > actions to        |
|      | / 5°F or       |              |        | > determine if the  |
|      | lower)         |              |        | > vaccine is still  |
|      |                |              |        | > viable and how to |
|      |                |              |        | > document actions  |
|      |                |              |        | > correctly.        |
+------+----------------+--------------+--------+---------------------+
| **   | Is food stored | > 1\. Yes    | >      | > Option 1- Yes to  |
| 21** | with vaccines  | >            | Option | > any unit          |
|      | in the         | > 2\. No     | > 2-   | >                   |
|      | refrigerator   |              | > No   | > Reviewer should   |
|      | or Freezer     |              | > to   | > instruct on why   |
|      |                |              | > all  | > food should not   |
|      |                |              | >      | > be stored with    |
|      |                |              |  units | > vaccine and       |
|      |                |              |        | > develop timeframe |
|      |                |              |        | > to correct        |
+------+----------------+--------------+--------+---------------------+

+---+------------------+-------------+--------+----------------------+
| * | **Question**     | **Response  | > **   | > **U                |
| * |                  | Options**   | Accept | nacceptable-Requires |
| \ |                  |             | able** | > Corrective Action  |
| # |                  |             |        | > in #32**           |
| * |                  |             |        |                      |
| * |                  |             |        |                      |
+---+------------------+-------------+--------+----------------------+
| * | Are vaccines     | 1.  Yes     | >      | > Option 1-Yes to    |
| * | stored in the    |             | Option | > any unit           |
| 2 | doors of the     | 2.  No      | > 2-No | >                    |
| 2 | refrigerator and |             | > to   | > Reviewer should    |
| * | freezer?         |             | > all  | >                    |
| * |                  |             | >      | instruct/demonstrate |
|   |                  |             |  units | > how to properly    |
|   |                  |             |        | > arrange stored     |
|   |                  |             |        | > vaccine.           |
+---+------------------+-------------+--------+----------------------+
| * | Is vaccine       | 1.  Yes     | >      | > Option 2-No to any |
| * | stored in the    |             | Option | > unit               |
| 2 | middle of the    | 2\. No      | > 1-   | >                    |
| 3 | storage unit and |             | > Yes  | > Reviewer should    |
| * | stacked with air |             | > to   | >                    |
| * | space between    |             | > all  | instruct/demonstrate |
|   | the stacks and   |             | >      | > how to properly    |
|   | side/back of the |             |  units | > arrange stored     |
|   | unit to allow    |             |        | > vaccine.           |
|   | cold air to      |             |        |                      |
|   | circulate around |             |        |                      |
|   | the vaccine?     |             |        |                      |
+---+------------------+-------------+--------+----------------------+
| * | Is there a "DO   | 1.  Yes     | >      | > Option 2- No to    |
| * | NOT DISCONNECT"  |             | Option | > any unit           |
| 2 | sign on the      | 2.  No      | > 1-   | >                    |
| 4 | refr             |             | > Yes  | > Reviewer should    |
| * | igerator/freezer |             | >      | > provide warning    |
| * | electrical       |             | > to   | > sign and offer to  |
|   | outlets?         |             | > all  | > assist in placing  |
|   |                  |             | >      | > sign in proper     |
|   |                  |             |  units | > location.          |
+---+------------------+-------------+--------+----------------------+
| * | Is there a "DO   | 1.  Yes     | >      | > Option 2, 3- No or |
| * | NOT DISCONNECT"  |             | Option | > Don't know to any  |
| 2 | sign on the      | 2.  No      | >      | > unit               |
| 5 | circuit breaker? |             |  1-Yes | >                    |
| * |                  | 3.  Don't   | > to   | > Reviewer should    |
| * |                  |     know    | > all  | > provide warning    |
|   |                  |             | >      | > sign and offer to  |
|   |                  |             |  units | > assist in placing  |
|   |                  |             |        | > sign in proper     |
|   |                  |             |        | > location           |
+---+------------------+-------------+--------+----------------------+
| * | Are short-dated  | 1.  Yes     | >      | > Option 2- No to    |
| * | vaccines stored  |             | Option | > any unit           |
| 2 | in front and     | 2.  No      | >      |                      |
| 6 | used first,      |             |  1-Yes |                      |
| * | rotating stock   |             | > to   |                      |
| * | effectively?     |             | > all  |                      |
|   |                  |             | >      |                      |
|   |                  |             |  units |                      |
+---+------------------+-------------+--------+----------------------+
| * | Can the          | 1.  Yes     | > O    | > Option 2- No       |
| * | clinic/practice  |             | ptions |                      |
| 2 | physically       | 2.  No      | > 1,   |                      |
| 7 | differentiate    |             | > 3    |                      |
| * | privately        | 3.  Not     | \*,4,5 |                      |
| * | purchased        |             | >      |                      |
|   | vaccine from     |  applicable | >      |                      |
|   | publicly         |     clin    | Option |                      |
|   | purchased        | ic/practice | > 1 is |                      |
|   | vaccine? To      |     is      | > acce |                      |
|   | answer yes,      |     located | ptable |                      |
|   | clinic/practice  |     in a    | > if   |                      |
|   | must be able to  |             | >      |                      |
|   | demonstrate how  |   universal | method |                      |
|   | this is done     |     state,  | >      |                      |
|   |                  |     has no  | allows |                      |
|   |                  |     private | > pr   |                      |
|   |                  |     stock   | ovider |                      |
|   |                  |             | > to   |                      |
|   |                  | 4.  Not     | > id   |                      |
|   |                  |             | entify |                      |
|   |                  |  applicable | >      |                      |
|   |                  |     clin    | public |                      |
|   |                  | ic/practice | > from |                      |
|   |                  |     serves  | > p    |                      |
|   |                  |     100%    | rivate |                      |
|   |                  |     VFC     | >      |                      |
|   |                  |             | stock. |                      |
|   |                  |    eligible | >      |                      |
|   |                  |             | Option |                      |
|   |                  |   children, | >      |                      |
|   |                  |     has no  |  3-uni |                      |
|   |                  |     private | versal |                      |
|   |                  |     stock   | > pu   |                      |
|   |                  |             | rchase |                      |
|   |                  | 5.  Other   | > gr   |                      |
|   |                  |             | antees |                      |
|   |                  |             | >      |                      |
|   |                  |             |  would |                      |
|   |                  |             | >      |                      |
|   |                  |             | select |                      |
|   |                  |             | > this |                      |
|   |                  |             | >      |                      |
|   |                  |             | method |                      |
|   |                  |             | > and  |                      |
|   |                  |             | > do   |                      |
|   |                  |             | cument |                      |
|   |                  |             | > that |                      |
|   |                  |             | > pr   |                      |
|   |                  |             | ovider |                      |
|   |                  |             | > does |                      |
|   |                  |             | > not  |                      |
|   |                  |             | > have |                      |
|   |                  |             | > p    |                      |
|   |                  |             | rivate |                      |
|   |                  |             | >      |                      |
|   |                  |             | stock. |                      |
|   |                  |             | >      |                      |
|   |                  |             | >      |                      |
|   |                  |             | Option |                      |
|   |                  |             | > 4    |                      |
|   |                  |             | > can  |                      |
|   |                  |             | > only |                      |
|   |                  |             | > be   |                      |
|   |                  |             | > se   |                      |
|   |                  |             | lected |                      |
|   |                  |             | > if   |                      |
|   |                  |             | > pr   |                      |
|   |                  |             | ovider |                      |
|   |                  |             | > has  |                      |
|   |                  |             | > C    |                      |
|   |                  |             | ompreh |                      |
|   |                  |             | ensive |                      |
|   |                  |             | >      |                      |
|   |                  |             |  Certi |                      |
|   |                  |             | ficate |                      |
|   |                  |             | > on   |                      |
|   |                  |             | > file |                      |
|   |                  |             | > and  |                      |
|   |                  |             | > the  |                      |
|   |                  |             | >      |                      |
|   |                  |             |  certi |                      |
|   |                  |             | ficate |                      |
|   |                  |             | > is   |                      |
|   |                  |             | > cu   |                      |
|   |                  |             | rrent. |                      |
+---+------------------+-------------+--------+----------------------+
| * | Upon checking    | 1.  Yes     | >      | > Option 1- Yes      |
| * | the              |             | Option |                      |
| 2 | c                | 2.  No      | > 2-   |                      |
| 8 | linic/practice's |             | > No   |                      |
| * | vaccine supply,  |             |        |                      |
| * | did reviewer     |             |        |                      |
|   | find any         |             |        |                      |
|   | unreported       |             |        |                      |
|   | wasted or        |             |        |                      |
|   | expired vaccine? |             |        |                      |
+---+------------------+-------------+--------+----------------------+

<http://www.cdc.gov/vaccines/programs/vfc/downloads/2008-vfc-site-visit-answ-key.doc>