Common Review Date

The assessment date for running the report, in MM/DD/CCYY format.

Client will be at least

Numeric entry field, followed by a drop-down selection choice of Days, Months, Years.

Client will be less than

Numeric entry field, followed by a drop-down selection choice of Days, Months, Years.

Org Name

Displays the name of the organization that the user is logged in under.

Generates the extract file.

Returns the user to the report screen.

Unique Client Identifier

The ImmTrac2 system ID that uniquely identifies the client.

Last Name

The client's last name.

First Name

The client's first name.

Date of Birth

The client's birth date.

Address Line 1

The first line of the client's address.

Address Line 2

The second line of the client's address.

City

The city of the client's address.

State

The state of the client's address.

Zip

The zip code of the client's address.

Blank Field

n/a

Blank Field

n/a

Blank Field

n/a

Shot Date

The date when the dose was administered.

Shot Type

The CVX code for the administered vaccine.

Moved or Gone Elsewhere

Y for a client who has a Moved or Gone Elsewhere status in this organization. Otherwise, N.

Provider Organization Identifier

The organization's Primary Client ID, found in the Update Client screen, under the Organization Information accordion.

Gender

The gender of the client. The values are as follows:

• 1 for Male

• 2 for Female

• 98 for Unknown

Ethnicity

The ethnicity of the client. The values are as follows:

• 1 for Not Hispanic or Latino
• 2 for Hispanic or Latino
• 98 for Unknown

VFC Eligibility

The dose-specific VFC eligibility. The values are as follows:

• 0 for empty
• 1 for Medicaid
• 2 for Native American/Alaskan Native
• 3 for Not VFC-Eligible
• 4 for Underinsured
• 5 for Uninsured