Dhec 1167 Template

When filling out the DHEC 1167 form, it is essential to keep several key points in mind. This form is used for documenting the borrowing of vaccines from both private and VFC stock.

• Provider Information: Begin by entering your Provider Identification Number along with your complete contact details, including name, address, and phone number.
• Accurate Documentation: For each vaccine borrowed, fill out all required fields. This includes the vaccine type, patient name, date of birth, date borrowed, and the reason for borrowing.
• Separate Entries: Each vaccine administered to a child must be recorded on its own line. This ensures clarity and accuracy in the records.
• Return Dates: Once the borrowed vaccine is replaced, make sure to note the return date in the designated column.
• Signature Requirement: The form must be printed, signed, and dated by the provider to validate the information provided.
• Communication: It is necessary to contact the SC VFC Program at (803) 898-0460 each time a borrowing event occurs.
• Retention of Records: Keep completed DHEC 1167 forms as part of your VFC program records for a minimum of three years.
• Compliance: Ensure that borrowing occurs only in unexpected situations, such as delayed shipments or spoiled vaccines, and not as a routine practice.
• Impact on Patients: Be mindful that borrowing VFC vaccines should not hinder a VFC-eligible child from receiving their necessary vaccinations.
• Legal Certification: By signing the form, the provider certifies that all reported information is accurate and complies with VFC provisions.

The DHEC 1167 form, also known as the SC VFC Vaccine Borrowing Report, is essential for documenting borrowed vaccines. In conjunction with this form, several other documents are frequently utilized to ensure compliance and proper record-keeping. Below is a list of these documents, each serving a specific purpose in the vaccine borrowing process.

• Provider Enrollment Form: This document is used by healthcare providers to enroll in the Vaccines for Children (VFC) program. It collects essential information about the provider's practice and eligibility to participate in the program.
• VFC Vaccine Order Form: Providers use this form to request vaccines from the VFC program. It details the types and quantities of vaccines needed, ensuring that providers maintain adequate inventory for eligible patients.
• Vaccine Inventory Log: This log tracks the inventory of vaccines on hand, including both VFC and private stock. It helps providers monitor their supplies and identify when to reorder vaccines.
• Incident Report Form: In cases where vaccines are spoiled or damaged, this form documents the incident. It provides a detailed account of the circumstances surrounding the loss, which is important for record-keeping and potential reimbursement.
• Hold Harmless Agreement Form: For those involved in activities with potential liabilities, the necessary Hold Harmless Agreement documentation offers protection against legal claims and disputes.
• Patient Vaccination Record: This record maintains a history of vaccinations administered to each patient. It includes details such as vaccine type, date administered, and any adverse reactions, ensuring comprehensive patient care.
• Compliance Audit Form: This form is used during audits to assess a provider's adherence to VFC program requirements. It includes criteria that providers must meet, ensuring proper usage and documentation of VFC vaccines.

These documents work together with the DHEC 1167 form to create a comprehensive system for managing vaccine inventory and ensuring compliance with VFC program regulations. Proper use of these forms is crucial for maintaining the integrity of the vaccination process and safeguarding public health.

• Borrowing is always acceptable. Many believe that borrowing VFC vaccine is a routine practice. In reality, it should only occur under unexpected circumstances, such as delays or spoilage.
• VFC vaccines can replace private stock. This is a common misconception. VFC vaccines are not meant to serve as a replacement for a provider's privately purchased vaccine inventory.
• All borrowed vaccines must be reported. While it is crucial to report borrowed vaccines, some think that only certain types need documentation. Every borrowed vaccine must be reported accurately.
• Providers can borrow vaccines indefinitely. Some assume that borrowing can be a long-term solution. However, routine or sustained borrowing is not acceptable and should be avoided.
• There are no consequences for improper borrowing. Many underestimate the seriousness of borrowing violations. Providers can face penalties under the False Claims Act and other applicable laws for inaccurate reporting.
• Only VFC-eligible patients can receive borrowed vaccines. While VFC vaccines should primarily serve eligible patients, providers must ensure that borrowing does not prevent any VFC-eligible child from receiving necessary vaccinations.
• Filing the form is optional. Some providers think that maintaining the SC VFC Vaccine Borrowing Report is not mandatory. In fact, it must be kept for three years as part of the VFC program records.
• Contacting the SC VFC Program is unnecessary. There is a belief that providers do not need to inform the SC VFC Program after borrowing. In reality, they must contact the program each time borrowing occurs.