Massachusetts Department Of Public Health
Training Module
Planning a Clinic/EDS/POD
In Response to Infectious Diseases,
Emergencies, or Disasters
Presented by:
Katie Reilly, RN, BSN, MPH
Infectious Disease Response Nurse
Massachusetts Department of Public Health
November 12, 2010
Learning Objectives
 Identify potential emergencies and
emergency response
 List steps in planning and operating a
clinic/EDS/POD
 Identify possible community assets and
resources in response to public health
threats
 Consider plans for internal and external
communication
2
An All-Hazards Approach to Planning
Are We Prepared?
Think Globally, Act Locally!
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What Could We Be Facing?
 Bioterrorist Attack:
 Anthrax, Plague…
 Infectious Disease:
 Influenza, SARS…
 Local Infectious Disease Response:
 Food Handler with Hepatitis A, Meningitis Case…
 Natural or Man-Made Disaster:
 Floods, Earthquakes, Nuclear events…
4
Local Response
 Timeline and scope of response depends
on type of disease or incident
 Identify site(s) where the local community
will receive vaccination/medication
 Staffing provided by local volunteers and
professionals
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“The Team”
F irst R esp o n d e rs
F ire /E M S
M e d ica l & M e n tal
H e alth S e rv ice s
Law
E n fo rce m e n t
P u b lic
H e alth
E m e rg e n cy
M anagem ent
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Incident Command System (ICS)
 Establishes Chain of Command
 Abbreviated version of ICS:
 Flexibility
 Scalability
 Span of control
 Most important thing to know:
 Direct Supervisor
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Pre-clinic Planning
CDC
8
Planning team considerations
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Target population
Required response
Capacity
Staff roles and job descriptions
Timeline
Location(s) and clinic flow
Communication
Security & safety issues
Process of vaccinating/dispensing
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Planning team considerations
 Legal Issues:
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Jurisdiction
Public health laws, regulations & standards
Licensure regulations
Liability protection
Consent (minor & intellectually impaired)
HIPAA & FERPA (privacy protection laws)
CORI & SORI (criminal background check)
Record retention requirements
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Develop an Operations Plan
 Identify leadership
 Identify space, location, dates, times of clinic
 Obtain authorization from federal/state/local
public health authorities (as needed)
 Obtain signed standing orders (for vaccine or
medication, and emergency)
 Order and arrange for delivery and appropriate
storage of vaccine/medication and clinic
supplies
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CDC
Develop an Operations Plan (cont.)
 Identify staff/volunteers, assignments, job
descriptions, necessary training and schedules
 Verify current credentials/licensure of staff (e.g.
CPR)
 Obtain necessary
paperwork/documentation/information
 Assign set up, breakdown, and clean up duties
 Determine client flow from arrival to departure
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Develop an Operations Plan (cont.)
 Capacity and estimated throughput
 Safety and security plans
 Accommodations for individuals requiring
additional assistance
 Just In Time Training (JITT), briefing and
debriefing of staff
 System to report problems and concerns
 Method for disposal of sharps/biohazards
13
Staffing your clinic
Potential volunteer sources:
 Medical Reserve Corps (MRC)
 Massachusetts System for the Advance Registration
(MSAR) of Volunteer Health Professionals (VHP)
 Civic organizations and faith-based groups
 Schools, colleges/universities
 Retired professionals
 Citizen Emergency Response Teams (CERT)
 Visiting Nurse Association (VNA)
 Occupational Health Nurses (OHN)
 American Red Cross (ARC)
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Workforce Protection Plan
 Developed to protect staff and encourage
participation
 Provides vaccine or prophylaxis to staff,
responders, health care workers
 Implement prior to opening site to the public
 Use as opportunity to practice operations plan
and modify as needed
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Internal Communication
Staff
 When: prior to, during and after clinic
 Who: all professionals and volunteers
 How: face-to-face, email, phones, walkietalkies, social networking, HHAN
 What: plans, dates, times, locations, trainings,
roles, schedules, supplies
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Internal Communication
Local Partners
 When: prior to, during and after clinic
 Who: public health, police, fire, EMS, MRC,
MSAR, hospitals, private providers, neighboring
communities
 How: face-to-face, email, phones, walkie-talkies,
ham radio, social networking, HHAN
 What: times, locations, schedules, plans, trainings
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Internal Communication
State and Federal Agencies
 When: prior to, during and after clinic
 Who: MDPH, MEMA, MSAR, FEMA, CDC
 How: email, HHAN, websites, conference calls,
webinars, webcasts, phones
 What: recommendations, guidance, resources,
policies, procedures, timeline, capacity,
surveillance reporting
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External Communication
Public
 When: prior to, during and after clinic
 Who: general/target/special populations
 How: newspaper, radio, TV, signage, Emergency
Broadcast System (EBS), reverse 911, local
cable, PSA’s, Facebook, Twitter, blogs, websites,
webcasts, webinars, interpreters, Connect - CTY
 What: rationale, recommendations, strategies,
plans, education, times and clinic locations
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Staffing Considerations
Target population
Severity of threat
Timeline/capacity involved
Demographics/special populations
Amount of vaccine/medication available
Staff available and their competency level
Screening process
Possible new and related cases of disease or
potential exposure identified in subsequent days
 Paperwork required (pre-populated)
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Choosing Sites
 Readily available, not
already committed
 Well known location(s)
 Adequate & accessible
facilities; consider:
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Floor space
Parking (staff/public)
Public transportation
Climate controlled
Refrigeration
Lighting
Restrooms
Kitchen area
Security (inside and
outside)
Landline/cell phone
reception/internet access
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Consider Scheduling Clinics with
Other Events/Activities
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Fairs
Sports events
Malls
Health screenings
Child safety events
Community events
Faith-based activities
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Vaccine/Medication
Management, Storage & Handling
 Points for vaccine/medication manager
to consider:
 Security
 Transportation
 Storage requirements
 Follow manufacturer’s/MDPH recommendations
on management, storage, handling and transport
of vaccine/medication
 Vaccine Unit: 617-983-6828
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Standing Orders
 Use current standing orders that are reviewed
and signed by a physician or medical director
and have on-site (vaccine/medication specific &
emergency orders)
 Orders should include: name of
vaccine/medication, dose, route/method of
administration and inclusion/exclusion criteria
 Model vaccine standing orders available at:
http://www.mass.gov/dph/imm
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Designated Areas of Clinic*
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Parking/drop off
Entry
Registration
Screening
Vaccination/dispensing
Observation
Emergency treatment
Exit/collection of forms (optional)
*Consider setting up in advance and combining areas and
functions based upon staff, population, facility….
CDC
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Start Here
Greeter/
Initial
Triage
Orientation/
Paperwork
Registration/
Forms Review
Important Note: Individuals may be sent to
Medical Aid and/or Support for assistance
at any point in the process. In addition,
health education may be taking place at
many points in the process.
Medical Aid and/or Support
Medical
Medical
Screening
Screening
Vaccine
Administration
Observation
(if needed)
Forms
Collection
Exit
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Suggested Supplies & Equipment
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Tables, chairs, privacy screens
Refrigerator, coolers, thermometers
Office supplies and required forms
Phones/walkie-talkies
Paper towels, tissues, trash containers/bags
Signage
Refreshments for staff in a secure area
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Suggested Vaccination/Medication
Dispensing Stations Supplies
 Vaccine/medication
 Cold packs w/plastic
containers
 Needles (different sizes)
 Safety syringes
 Sharps/biohazard
containers
 Latex free gloves
 Hand sanitizer
 Pill crusher
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Water/cups
Medicine cups
Teaspoons/bowls
Alcohol wipes
Gauze/bandages
Adhesive tape
Tissues/paper towels
Table coverings
Trash containers/bags
Required forms/pens
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Safety & Security Planning
 Maintain a list of authorized staff for each clinic
 Establish staff sign-in/sign-out procedures,
including identification (e.g. name tags, vests)
 Develop policies and identify locations to secure
vaccine/medication and supplies
 Plan to flex staff to meet demand and avoid
bottlenecks
 Consider availability of police, fire and EMS
CDC
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Crowd Control Planning
 Designate personnel for crowd & traffic control to:
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Hand out forms
Maintain order/diffuse tension
Update crowd about wait times
Answer questions and concerns
 Make accommodations for individuals in need of
additional assistance
 May use ropes & signage to direct traffic flow
 Place Signage at a level where people can see
CDC
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Signage for:
 Clinic location
 Important information/instruction for target
populations
 One-way flow of traffic inside EDS
 Diverse populations (use universal & specific
languages) as needed
 Designated clinic areas
 Entrances, exits, restrooms
 Inside and outside facility
CDC
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Clinic Set Up
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Prior to Opening Clinic
 Designate and set up areas and stations
 Transport and secure
vaccine/medication
 Provide All-Staff Briefing and JITT
 Ensure signage is posted and placed
correctly
 Vaccination/Medication provided to work
force and their families
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Staff Expectations:
Wear appropriate attire
Arrive on time for scheduled shift
Sign in-arrival time, name, address, etc.
Sign out for breaks and at end of shift
Have picture ID, name tag, or vest
Receive job assignment/job action sheet
Receive Direct Supervisor’s name
Attend All-Staff Briefing and Just In Time Training
(JITT)
 Set up stations
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CDC
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Parking and Entry Area
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Drop off for mobility impaired
Provide escorts/assistance
Parking instruction
Relay information to clients about:
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Target population
Vaccine/medication available
Hours of operation
Clinic flow
 Provide interpreters
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Registration/Orientation Area
 Distribute necessary forms, such as:
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Disease Fact Sheet
Vaccination Information Statements (VIS)
Medication information sheets
Screening forms
Billing information forms (if applicable)
Consent forms (if applicable)
Release of information forms (if applicable)
 Assist with form completion and answer questions as
needed
 Consider posting forms online ahead of time, and/or
distributing at libraries, city hall, fire station, etc
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Screening Area
 Screen for contraindications or precautions to
vaccine/medication
 Answer questions or refer to Direct Supervisor
 Protect confidentiality and privacy
 Ask only “need to know” information for safe
administration of vaccine or medication
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Clinical/Dispensing Area
 Appropriate forms should be completed before
entry into clinical/dispensing area
 Staff/signage will direct clients to appropriate
station
 Administer vaccine/dispense medication
 Restrict access to this area in order to:
 Reduce noise and confusion
 Protect privacy and confidentiality
 Support safety and security plans
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Vaccine/Medication
Preparation, Administration and/or Dispensing
Points to consider:
 Policies and procedures
 Standing orders (signed)
 Staff competencies
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Vaccine/Medication Administration
Emergency Response
 Medical
 Facility
 Manufacturers and formulations
 Necessary documentation
 Supplies
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Clinical Documentation
 Pre-populate forms if possible
 Must be accurate, legible, and complete
 Must be secured and retained
 Consider electronic documentation
 May provide vaccine/medication record
to the client
 Provide VIS to client for immunizations
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Required Documentation
for Administration of Vaccine
 Patient’s name
 Vaccine name, manufacturer, lot number, expiration
date and dose number
 Publication date on VIS, date VIS was given
 Anatomical site, route and dose amount
 Date vaccine administered
 Vaccinator’s name, initials, signature, and credentials
 Clinic name, address and contact person
 Signed consent is not required except when a
parent/guardian is not present
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Vaccine Information Statement (VIS)
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Conveys risks and benefits of vaccine
Produced by CDC
Required by federal law
Vaccine specific
Must use current edition and not altered
Give before each dose of each vaccine
Provide an opportunity to ask questions
Available in multiple languages at:
www.immunize.org/vis
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Medication Documentation
Patient name
Age, weight (children)
Type of medication
Manufacturer
Lot number and expiration date
Date the medication was administered/dispensed
Dose and route
Name and address of the clinic site and contact
person
 Name, initials, signature, and credentials of dispenser
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Medication Information Sheet
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Name and formulation of medication
Directions for use
Dosing administration information
Signs & symptoms of adverse reaction/side
effects
 Contact information for questions or
concerns
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Observation Area
 Observe for 15-20 minutes after
vaccination
 Especially if first time receiving vaccine
 Monitor for signs and symptoms of adverse
reactions
 Provide educational materials, entertainment
and refreshments (as available)
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Expect The Unexpected
Plan for emergencies with personnel, facilities and
equipment/supplies
Obtain signed and current Emergency Standing
Orders from physician or medical director prior to
clinic*
*Model Emergency Standing Orders can be found at:
http://www.mass.gov/dph/imm
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Emergencies
 Adverse reactions to
vaccine/medication
 Other medical emergencies
 Police/Security emergencies
 Fire emergencies
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Emergency Response
 Onsite emergency responders
(whenever possible)
 Community resources (ex. fire, EMS,
police, local hospital)
 Emergency medical equipment and
supplies
 Phone availability, location and 911
access
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Emergency Supplies
 BP cuff and
stethoscope (child &
adult, extra-large
cuffs)
 Cell phone or access
to an on-site phone
 3x3 gauze pads
 Alcohol wipes
 Bandages
 Hand sanitizer
 Latex free vinyl gloves
(small, medium, large
& extra large)
 Flashlight & batteries
 Thermometer & probe
covers
 Instant cold packs
 Cots, Blankets,
Pillows
 Wrist watch with
second hand
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Emergency Supplies, continued….
 Acetaminophen 325 mg
tablets
 Ibuprofen 200mg tablets
 Diphenhydramine 25 mg
tablets
 Diphenhydramine 50 mg
injectable-(carpujet)
 Diphenhydramine elixir
12.5mg/5ml
suspension 25mg/5ml
 Epipen & Epipen Jr. &
Aqueous Epinephrine
1:1000 injectable 1mg/ml
 Syringes-3mL-1” 23g, 5/8”
25g, 1mL
 Ammonia inhalant
 Airways (large & small)
 Pocket masks with one
way valve (adult &
pediatric)
 Tongue depressors
 AED
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Exit Area
 Collect forms (if applicable)
 Answer questions and report concerns
 Complete exit survey (if applicable)
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Exit Survey
Consider surveying clients for relevant
information such as:
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How did you hear about the clinic?
How did you get to the clinic?
How long did you wait?
What did you like?
What didn’t you like?
Where do you live?
CDC
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Post Clinic Paperwork
 Adhere to medical record retention rules for
keeping administration records
 Compile billing information (if applicable)
 Complete MDPH Vaccine Aggregate Usage
forms
 Complete VAERS forms, incident and
medication error reports if indicated
CDC
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Post Clinic
 Ensure proper storage and handling of unused
vaccine/medication
 Contact MDPH regarding unused and expired
state-supplied vaccine/medication
 Return equipment and unused supplies
 Dispose of sharps and medical waste
 Hold staff debrief/hotwash at end of clinic, or
schedule a debriefing for later date
 Ensure staff signs out
CDC
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Staff Debriefing
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What worked?
What didn’t work?
Clinic challenges
Planning priorities for future
Future availability of resources
Additional suggestions/comments
CDC
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Some Common Pitfalls in Planning
 Assumption that everyone is on the same
page
 Different terms and concepts across
disciplines
 Too many spokespeople
 Lack of training
 Misinterpretation of roles
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MDPH Contact Numbers
 MDPH Epidemiology/Immunization
Program
617-983-6800 (24x7)
888-658-2850
 MDPH Vaccine Unit
617-983-6828
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Seasonal Flu Vaccine Reimbursement
 Commonwealth Medicine (part of UMASS Medical School) is
working with public & private health plans to provide
reimbursement for the administration of the seasonal
influenza vaccine in the public setting.
 Complete one insurance form for each individual who receives
a vaccination
 Have vaccine recipient, or parent/guardian sign and date the
form
 Fill out info in the Clinic/Office Use section for providers and
sign and date the form
 Submit forms via email or regular mail
 Forms and more information available online at:
http://www.umassmed.edu/commed/flu-reimb/index.aspx
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Online Resources
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MDPH Guidelines for Compliance with Federal and State
Vaccine Administration Requirements
http://www.mass.gov/Eeohhs2/docs/dph/cdc/immunization/guid
elines_vaccine_compliance.pdf
MDPH General Protocol for Vaccine Storage, Administration,
Standing Orders,& Immunization Clinics, Sept 2009
http://www.mass.gov/Eeohhs2/docs/dph/cdc/immunization/mso
_protocols_general.pdf
MMWR: General Recommendations on Immunization,
Recommendations of the Advisory Committee on Immunization
Practices (ACIP), December 2006
http://www.cdc.gov/mmwr/pdf/rr/rr5515.pdf
CDC Guidelines for Setting Up Vaccination Clinics
http://www.cdc.gov/h1n1flu/vaccination/statelocal/settingupclinic
s.htm
World Health Organization
http://www.who.int/en
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Online Resources
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Massachusetts Department of Public Health (MDPH)
http://www.mass.gov/dph
MDPH Immunization Program
http://www.mass.gov/dph/imm
Immunization Action Coalition
www.immunize.org
Centers for Disease Control and Prevention (CDC)
http://www.cdc.gov
Epidemiology and Prevention of Vaccine-Preventable Diseases, The Pink
Book: Course Textbook (11th Edition), May 2009
http://www.cdc.gov/vaccines/pubs/pinkbook/default.htm#download
Vaccine Administration Errors to the Institute for Safe Medication Practices
www.ismp.org
Guide to Vaccine Contraindications and Precautions
http://www.cdc.gov/vaccines/recs/vac-admin/downloads/contraindicationsguide-508.pdf
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Online Resources
 MassPro for Flu clinic locations
http://www.masspro.org
 Adverse Events to Vaccine Adverse Events Reporting System
(VAERS)
http://www.vaers.hhs.gov
 School Located Vaccination: Information for planners
www.cdc.gov/h1n1flu/vaccination/slv/planners.htm
 Massachusetts Division of Health Professions Licensure
License Verification Site
https://licensecheck.hhs.state.ma.us/mylicenseverification/
 Sharps disposal companies from the Massachusetts Department
of Environmental Protection
http://www.mass.gov/dep/recycle/hazardous/medical.htm
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Online Resources
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Recommendations for Drawing-Up Vaccine and Other Documentations
Requirements for Clinical Sessions or Large Clinics
http://www.mass.gov/Eeohhs2/docs/dph/cdc/immunization/mso_recomm
endation_drawing_up_vaccine.pdf
CDC Guidelines for Large-Scale Influenza Vaccination Clinic Planning
http://www.cdc.gov/flu/professionals/vaccination/vax_clinic.htm
Commonwealth of Massachusetts, Department of Public Health,
Emergency Dispensing Site, Management and Operations
http://www.mass.gov/Eeohhs2/docs/dph/emergency_prep/emergency_di
spensing_site_intro.pdf
A Guide to the Massachusetts Public Records Law
http://www.sec.state.ma.us/pre/prepdf/guide.pdf
MDPH: Holding a Vaccination Clinic
http://www.mass.gov/?pageID=eohhs2subtopic&L=8&L0=Home&L1=Pr
ovider&L2=Guidelines+and+Resources&L3=Guidelines+for+Services+%
26+Planning&L4=Diseases+and+Conditions&L5=Influenza&L6=Season
al+Flu&L7=Vaccine+Administration&sid=Eeohhs2
62
Please join us for the other training
modules!
 All-Staff Briefing & Just-In-Time Training:
November 15th, 3:00-4:30
 Vaccine Management, Storage and
Handling: November 16th, 3:00-4:00
 Vaccine and Medication Preparation and
Administration: available online soon!
10/3/2015
63
QUESTIONS??
Thank You !
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