The District of Columbia Department of Health (DOH) requests interested vaccine providers to signup to receive H1N1 influenza vaccine. DOH 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-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. This agreement will be available shortly from the Centers for Disease Control and Prevention (CDC).

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 Department of Health at h1n1.vaxsite@dc.gov 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.

Select Here for Pre-Registration Sign-Up for H1N1 Influenza Vaccine Administration Sites  (Online Form)

Next Steps
The following forms will ultimately need to be submitted before vaccine is shipped to your site. We anticipate that vaccine supplies will be available in mid-October, but may be available as early as the last week of September. These documents are not yet available but will be emailed or faxed to the H1N1 Point of Contact for completion when provided by CDC.

• 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 Contact:
District of Columbia Department of Health at: h1n1.vaxsite@dc.gov (202) 671-4222