Wyoming COVID-19 Vaccine Information for Providers

The Wyoming Immunization Unit is excited to begin enrolling COVID-19 Vaccine Program Providers. Enrollment is required to receive COVID-19 vaccine from the Unit. The Immunization Unit thanks you in advance for working with us to ensure the success of the COVID-19 vaccination efforts in Wyoming. 

The link to the PDF version of the COVID-19 Vaccination Program Provider Agreement is below. It is very important that you read through and then follow the instructions provided here to ensure successful completion.

There are two parts to the Provider Enrollment Agreement:

1. Section A
   1. COVID-19 Vaccination Program Provider Requirements and Legal Agreement: This section must be completed with information about the Organization.
2. Section B
   1. CDC COVID-19 Vaccination Program Provider Profile Information: This section must be completed for each location (one or more) where individuals will be vaccinated, whether the location receives COVID-19 vaccine directly shipped or vaccine transferred from another location. 
   2. For example:
      1. The Organization has five associated facilities, including the main facility. Only three of these facilities, including the main one, will administer COVID-19 vaccine when it is available. Two of the three facilities intend to receive shipments of the vaccine directly; however, the third location will receive doses from one of the other associated facilities.
         1. Three total PDF Agreements will need to be completed and sent back to the Immunization Unit. Section A will be the same for all three documents. Section B will be specific to each individual facility. 
3. We recommend that if there is more than one facility that will be enrolled as a COVID-19 Vaccine Provider location you complete the information in Section A and then save a copy for each of the associated locations. This will alleviate the need to re-enter the information into Section A each time.
4. All information needs to be completed in the electronic format of the Agreement, including signatures. Please do not print the form at any time during this process.
5. Once the information is entered into the PDF and all electronic signatures are obtained, you will need to save the file and email it back to the Immunization Unit. Tips for this process are as follows:

1. 1. Open the PDF attachment (download a free version of Adobe Reader, if necessary)
   2. Save a copy of the document in a known location such as your Desktop, Documents, or other folder,
      1. File > Save As > [select the desired file location] > Save
   3. Complete the form fields,
   4. Save the PDF,
   5. Close the PDF,
   6. Attach the PDF in an email to wdh.covidenrollment@wyo.gov. 

After the Immunization Unit reviews the information and processes the form, the contacts listed will receive an email with information and next steps. Please expect at least two weeks before receiving additional information as we are working to finalize the onboarding process.   

The Immunization Unit can answer questions you may have by emailing wdh.covidenrollment@wyo.gov with questions.

You are also encouraged to utilize the Provider Enrollment Agreement Form FAQ document.

Wyoming COVID-19 Vaccine Program Provider Enrollment Agreement

As previously communicated, each Vaccine Coordinator is required to complete assigned training modules prior to the facility being eligible to administer COVID-19 vaccine. 

The first training module available that is required for Vaccine Coordinators and recommended for all staff is: 

• COVID-19 Vaccine Training: General Overview of Immunization Best Practices for Healthcare Providers 

  • Please complete and follow instructions at the end of the module for printing your certificate of completion. Certificates must be submitted for each Vaccine Coordinator in order for training to be counted as complete. 

  • Certificates of completion should be sent to wdh.covidenrollment@wyo.gov. 

    • The facility will not be eligible to administer COVID-19 vaccine until all documentation is submitted to the Immunization Unit.

Additional product-specific training will be required once the COVID-19 vaccines are approved for use. The additional modules will be made available as soon as possible. 

• Moderna COVID-19 Vaccine EUA Letter of Authorization
  • Fact sheet for healthcare providers
  • Fact sheet for recipients and caregivers
• Moderna materials, including standing orders, are available on the CDC website at: https://www.cdc.gov/vaccines/covid-19/info-by-product/moderna/index.html

Janssen-specific documents

• Janssen COVID-19 Vaccine EUA Letter of Authorization
  • Fact sheet for healthcare providers
  • Fact sheet for recipients and caregivers

Other Documents and templates

V-Safe Poster

V-Safe Information Sheet

• V-safe is a smartphone-based tool that uses text messaging and web surveys to provide personalized health check-ins after someone receives a COVID-19 vaccination. Through v-safe, vaccine recipients can quickly tell CDC if they have any side effects after getting the COVID-19 vaccine. Depending on their responses, CDC may follow up with them by phone to get more information. V-safe will also remind them to get their second COVID-19 vaccine dose, if needed.  
• CDC is requesting that healthcare providers give patients a v-safe information sheet at the time of vaccination and encourage them to enroll and fill out the surveys when prompted to do so. The information sheet explains v-safe and provides step-by-step instructions on how to sign up to participate. Vaccine recipients can use the QR code or URL on the information sheet to sign up at their convenience.  

Wyoming Immunization Registry (WyIR) Resources and User Guides

• Vaccine Data Entry Guide
• Reminder/Recall Guide
• Add/Edit Vaccinations Quick Reference Guide
• Vaccine Orders Quick Reference Guide
• Vaccine Transfers Quick Reference Guide
• Vaccine Inventory Management Quick Reference Guide
• Correct Lot Decrementing Guide (for interface connections only)
• Dose Count Variance Reference Guide

Mass Immunizations Module

• Mass Immunizations Module Overview
• Mass Immunizations Quick Start Guide
• Waiting Room Quick Reference Guide
• Bar Code Scanner Use and Scan Sheets Guide
• Reports Quick Reference Guide
• Default Settings Quick Reference Guide