Registration Questions tab

Purpose

The Registration Questions accordion tab captures the organization's category and type through a series of questions that the user needs to answer.

Based on the answers to questions 1 and 2 on the tab, relevant accordion tabs will be populated.

Based on the organization type selected, if the organization participates in the ASN program, additional questions 5, 6 and 7 will be populated.

Question #	Registration Questions	Yes/No	Accordion Tab display
1	Does you organization administer immunizations?	Yes	Organization Demographics Parent/Headquarters Info Organization Point of Contact (POC) User Accounts Info Responsible Medical Provider or Authorized Signer Practicing Providers with Prescribing Authority Data Exchange Agree and Sign
1	Does you organization administer immunizations?	No	Organization Demographics Parent/Headquarters Info Organization Point of Contact (POC) User Accounts Info Agree and Sign
2	The TVFC Program serves financially vulnerable children from birth through 18 years of age. Would you like to be contacted with more information on the TVFC Program?	Yes	Organization Demographics Parent/Headquarters Info Organization Point of Contact (POC) User Accounts Info Responsible Medical Provider or Authorized Signer Practicing Providers with Prescribing Authority Data Exchange Agree and Sign
2		No	Organization Demographics Parent/Headquarters Info Organization Point of Contact (POC) User Accounts Info Responsible Medical Provider or Authorized Signer Practicing Providers with Prescribing Authority Data Exchange Agree and Sign
3	Would you like to enroll in the TVFC Program now?	Yes	Organization Demographics Parent/Headquarters Info Organization Point of Contact (POC) User Accounts Info Medical Director or Equivalent (Responsible Medical Provider) Practicing Providers with Prescribing Authority Client Demographic Info TVFC Coordinator Info Vaccines Offered/Delivery Info Provider Population Estimates TVFC Provider Agreement Data Exchange Agree and Sign
3	Would you like to enroll in the TVFC Program now?	No	Organization Demographics Parent/Headquarters Info Organization Point of Contact (POC) User Accounts Info Responsible Medical Provider or Authorized Signer Practicing Providers with Prescribing Authority Data Exchange Agree and Sign
4	Select your Organization Type	N/A	Select organization type from the drop down menu
	Questions 5, 6 and 7 are populated if Organization Type selected is eligible to participate in the ASN Program The following organization types are applicable: • Local Health Department • Federally Qualified Health Clinic • Rural Health Clinics • Family Planning • STD/HIV Clinics • Drug Treatment Facility
5	The ASN Program serves uninsured adults 19 and over. Would you like to be contacted with more information on the ASN Program?	Yes	Based on organization type selected from above list: Organization Demographics Parent/Headquarters Info Organization Point of Contact (POC) User Accounts Info Medical Director or Equivalent (Responsible Medical Provider) Practicing Providers with Prescribing Authority Client Demographic Info TVFC Coordinator Info Vaccines Offered/Delivery Info Population Provider Estimates TVFC Provider Agreement Data Exchange Agree and Sign
5		No	Based on organization type selected from above list: Organization Demographics Parent/Headquarters Info Organization Point of Contact (POC) User Accounts Info Medical Director or Equivalent (Responsible Medical Provider) Practicing Providers with Prescribing Authority Client Demographic Info TVFC Coordinator Info Vaccines Offered/Delivery Info Population Provider Estimates TVFC Provider Agreement Data Exchange Agree and Sign
6	Would you like to enroll in the ASN Program now?	Yes	Organization Demographics Parent/Headquarters Info Organization Point of Contact (POC) User Accounts Info Medical Director or Equivalent (Responsible Medical Provider) Practicing Providers with Prescribing Authority Client Demographic Info TVFC Coordinator Info Vaccines Offered/Delivery Info Population Provider Estimates TVFC Provider Agreement ASN Provider Agreement Data Exchange Agree and Sign
6	Would you like to enroll in the ASN Program now?	No	Organization Demographics Parent/Headquarters Info Organization Point of Contact (POC) User Accounts Info Medical Director or Equivalent (Responsible Medical Provider) Practicing Providers with Prescribing Authority Client Demographic Info TVFC Coordinator Info Vaccines Offered/Delivery Info Population Provider Estimates TVFC Provider Agreement Data Exchange Agree and Sign
7	Will your organization administer vaccines under ONLY the adult program, or both adult and pediatric programs? (Populated when user answers 'Yes' to Question 6)	Adult (ASN)	Organization Demographics Parent/Headquarters Info Organization Point of Contact (POC) User Accounts Info Medical Director or Equivalent (Responsible Medical Provider) Practicing Providers with Prescribing Authority Client Demographic Info TVFC Coordinator Info Vaccines Offered/Delivery Info Population Provider Estimates TVFC Provider Agreement ASN Provider Agreement Data Exchange Agree and Sign
7		Adult and Pediatric (TVFC and ASN)	Organization Demographics Parent/Headquarters Info Organization Point of Contact (POC) User Accounts Info Medical Director or Equivalent (Responsible Medical Provider) Practicing Providers with Prescribing Authority Client Demographic Info TVFC Coordinator Info Vaccines Offered/Delivery Info Population Provider Estimates TVFC Provider Agreement ASN Provider Agreement Data Exchange Agree and Sign

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