I attest that I have logged into my myCAvax account and updated all applicable information pertaining to my location and/or contacted the myCAvax helpdesk to reactivate my existing account and updated all applicable information.

If pick-up is indicated, a member of the San Bernardino County Immunizations Team will reach out to coordinate further.

For each influenza immunization given, partner will retain a record which includes the patient's name, age category, manufacturer, lot number, and expiration date.

Provider will charge any patient or third party no more than $2.00 as a fee for administering the vaccine, or what is authorized by County Board of Supervisors (as noted by Government Section Code 54985) or what is authorized by Medicare (refer to exceptions as noted on CMS' website: Medicare Part B Drug Average Sales Price | CMS). No charge will be made for the vaccine itself. In addition, provider agrees to comply with the Federal requirements regarding persons aged 65 and older, who have Part B Medicare coverage. No Medicare Part B beneficiary, aged 65 and older, should be required to pay out of pocket expenses for receipt of influenza vaccine.

Provider agrees to follow VFC/CDPH standards for storage and handling of vaccine, including standards related to the transport of vaccine to community locations for mass vaccination clinics. Information on storage and handling can be found at California Vaccines for Children (VFC) Online Immunization Training (eziz.org). Provider agrees to utilize proper storage units and calibrated digital data loggers (DDLs).

Provider agrees to complete all reporting forms on a weekly basis by 6:00 P.M. every Monday or within 3 business days of an influenza clinic, whichever comes first. If no doses were administered in any given week, a report displaying zero doses administered is still required.

All doses administered will be documented in the California Immunization Registry (CAIR2).

All immunizers are trained and working under the supervision of a licensed medical provider.

Licensed medical providers and their staff will exercise individualized medical judgement in prescribing influenza immunization for each patient and/or staff member; AND the medical provider will provide to each (or legal guardian) and/or staff member receiving influenza vaccine, a copy of the Vaccine Information Statement (VIS).

Each patient or staff member will be allowed adequate time for reading the information and asking questions before vaccine administration.

All documentation will be retained for a period of at least three (3) years.

Facilities administering influenza vaccine are asked to promptly report any adverse health events experienced by influenza vaccines that occur within 4 weeks of administration and require medical attention to the Vaccine Adverse Event Reporting System (VAERS) and/or errors in vaccine administration to the Health Care Practioner's Vaccine Error Reporting Form (VERP). Providers must also promptly report adverse health events or vaccine administration error to their local health department.