Field Name |
Description |
Editable Admin
Role |
IIS Status |
Radio button
to select if a provider organization is Open or Closed |
No |
Org Id |
Auto-generated
ID for the provider organization. |
No |
Name |
Required. Free-text field and
has no default value. Provider Organization Name. Minimum length
is 1; maximum length is 95. |
Yes |
Org Code |
Required. Free-text field and has
no default value. Provider Organization ALERT Site #. Minimum
length is 1; maximum length is 8; any character allowed. |
No |
Org Type |
Required.
Organization
Type pick list. Type of provider organization. |
No |
Federal Designation |
Radio button
to select an attribute used to determine vaccine eligibility codes
for the provider organization. |
No |
Public Org |
Radio button
to select if the provider organization is Public Organization. Determines vaccines the provider organization
can order. Default value = No. |
No |
County Org |
Radio button
to select if the provider organization is a County Health Organization.
Selecting a county with County Org
= Yes will enable provider organization to run Reminder Recall
and Assessment reports for patients living in the county specified.
Default value = No. |
No |
State Reminder/Recall |
Radio button
to select if the provider organization is included in the Statewide
Reminder Recall program. Default value = No. |
No |
Immunize 0-6 |
Radio button
to select for Yearly CDC Reporting. Default value = No |
No |
Return Patients
without imms |
Radio button
to select if the provider organization outbound data exchange
returns patients without immunizations. Default value =
No. |
No |
County |
Oregon County
pick list. Default = No county selected. |
Yes |
Hospital FPI |
Free-text field
and has no default value. Provider Organization Hospital FPI code.
Maximum length is 8; any character allowed. |
No |
Data Source |
Required. Data Source pick list. Provider
Organization Data Source Type. Default = No Data Source selected. |
No |
Data Source Organization |
Required if Data Source = Parent Or Vendor.
Parent Organization pick list. Provider Organization's
Data Source Provider Organization. Default = No Data Source Organization
selected. |
No |
Parent Organization |
Displays if Data Source = Self Or Vendor.
All Active Provider Organizations pick list. Provider Organization's
Parent Organization. Default = pick list will not display. |
No |
Is a Satellite of |
All Active Provider
Organizations pick list. Provider Organization that the Provider
Organization is the Satellite of. Default = No Provider Organization
selected. |
No |
Is a Delegate of |
All Active Provider
Organizations pick list. Provider Organization that the Provider
Organization is the Delegate of. Default = No Provider Organization
selected. |
No |
Source Type |
Required. Data Exchange Source
of Provider Organization pick list. Default = No Source Type selected. |
No |
Submission Type |
Submission Type
of data exchange pick list. Default = No Submission Type selected. |
No |
Last UI Submission |
Last Client-related
update via User Interface for the Provider Organization. |
No |
Last DX Submission |
Last Client-related
update via data exchange for the Provider Organization. |
No |
Applications |
Applications
that the provider organization is able to use. |
No |
VFC Pin |
Free-text fields
and has no default value. Provider Organization VFC Pin.
Maximum length is 6; any character allowed. |
No |
VFC Status |
VFC Status pick
list. Provider Organization VFC Status for Provider Organization
and Vaccine Order. Default = No VFC Status selected. |
No |
Varicella Certified |
Radio button
to select the provider organization vaccine ordering of Varicella.
Default = No. |
No |
VFC Only |
Radio button
to select the provider organization for VFC vaccine ordering. |
No |
Billing Begin Date |
|
No |
Billing End Date |
|
|
Tier|Frequency |
Tier|Frequency
pick list. Tier|Frequency of the Ordering capabilities of
the Provider Organization. Default = No Tier|Frequency selected. |
No |
Delivery Days |
Check box of
what days vaccine deliveries are accepted for the Provider Organization.
Default = No check boxes selected. |
Yes |
Delivery Window
1 |
Time pick list.
First Delivery Window of when vaccine deliveries are accepted
for the Provider Organization. Default = 9:00a.m. - 5:00p.m. |
Yes |
Delivery Window
2 |
Time pick list.
Second Delivery Window of when vaccine deliveries are accepted
for the Provider Organization. Default = No time frame selected. |
Yes |
Main Contact Phone |
Area Code: 3
digits. Prefix: 3 digits. Suffix: 4 digits. Provider
Organization Main Phone Contact. |
Yes |
Main Contact Phone
Extension |
Up
to 7 digits. Provider Organization Main Phone Contact Extension. |
Yes |
Main Contact Facsimile |
Area Code: 3
digits. Prefix: 3 digits. Suffix: 4 digits. Provider Organization
Main Contact Facsimile. |
Yes |
Main Contact Facsimile
Extension |
Up to 7 digits.
Provider Organization Main Contact Facsimile Extension. |
Yes |
Main Contact Email |
Free-text field
and has no default value. Maximum length is 100; any character
allowed. Provider Organization Main Contact Email address. |
Yes |
Physical Address
1 |
Free-text field
and has no default value. Maximum length is 55; any character
allowed. Provider Organization Physical Address. |
Yes |
Physical Address
2 |
Free-text field
and has no default value. Maximum length is 55; any character
allowed. Provider Organization Physical Address. |
Yes |
Physical PO Box |
Free-text field
and has no default value. Maximum length is 55; any character
allowed. Provider Organization Mailing PO Box. |
Yes |
Physical City |
Free-text field
and has no default value. Maximum length is 52; any character
allowed. Provider Organization Physical City in which it resides. |
Yes |
Physical State |
State pick list
pre-populated with the state abbreviations. Default = OR. |
Yes |
Physical ZIP |
Free-text field
and has no default value. Maximum length is 5; numeric characters
only allowed. Provider Organization Physical Zip Code. |
Yes |
Physical +4 |
Free-text field
and has no default value. Maximum length is 4; numeric characters
only allowed. Provider Organization Physical +4 of Zip Code. |
Yes |
Geocoded |
Physical Address
has or has not been geocoded. |
No |
Populate With Physical
Address |
Check box to
populate the Mailing Address information with the Physical Address
Information |
Yes |
Mailing Address
1 |
Free-text field
and has no default value. Maximum length is 55; any character
allowed. Provider Organization Mailing Address. |
Yes |
Mailing Address
2 |
Free-text field
and has no default value. Maximum length is 55; any character
allowed. Provider Organization Mailing Address. |
Yes |
Mailing PO Box |
Free-text field
and has no default value. Maximum length is 55; any character
allowed. Provider Organization Mailing PO Box. |
Yes |
Mailing City |
Free-text field
and has no default value. Maximum length is 52; any character
allowed. Provider Organization Mailing City in which mail is sent. |
Yes |
Mailing State |
State pick list
pre-populated with the state abbreviations. Default = OR. |
Yes |
Mailing ZIP |
Free-text field
and has no default value. Maximum length is 5; numeric characters
only allowed. Provider Organization Mailing Zip Code. |
Yes |
Mailing +4 |
Free-text field
and has no default value. Maximum length is 4; numeric characters
only allowed. Provider Organization Mailing +4 of Zip Code. |
Yes |
Geocoded |
Mailing Address
has or has not been geocoded. |
No |
Populate With Physical
Address |
Check box to
populate the Vaccine Delivery Address information with the Physical
Address Information |
Yes |
Vaccine Delivery
Address 1 |
Free-text field
and has no default value. Maximum length is 55; any character
allowed. Provider Organization Vaccine Delivery Address. |
Yes |
Vaccine Delivery
Address 2 |
Free-text field
and has no default value. Maximum length is 55; any character
allowed. Provider Organization Vaccine Delivery Address. |
Yes |
Vaccine Delivery
PO Box |
Free-text field
and has no default value. Maximum length is 55; any character
allowed. Provider Organization Vaccine Delivery PO Box. |
Yes |
Vaccine Delivery
City |
Free-text field
and has no default value. Maximum length is 52; any character
allowed. Provider Organization Vaccine Delivery City in which
vaccines are delivered. |
Yes |
Vaccine Delivery
State |
State pick list
pre-populated with the state abbreviations. Default = OR. |
Yes |
Vaccine Delivery
ZIP |
Free-text field
and has no default value. Maximum length is 5; numeric characters
only allowed. Provider Organization Vaccine Delivery Zip
Code. |
Yes |
Vaccine Delivery
+4 |
Free-text field
and has no default value. Maximum length is 4; numeric characters
only allowed. Provider Organization Vaccine Delivery +4
of Zip Code. |
Yes |
Geocoded |
Vaccine Delivery
Address has or has not been geocoded. |
No |
Individual Contact
Role |
Required. Role pick list pre-populated
with the Roles of contacts for a Provider Organization. |
Yes |
Individual Contact
Last Name |
Required. Free-text field and
has no default value. Minimum length is 1; Maximum length is 50;
Alphanumeric characters only allowed. Last Name of Individual
Contact being added to the Provider Organization. |
Yes |
Individual Contact
First Name |
Required. Free-text field and
has no default value. Minimum length is 1; Maximum length is 50;
Alphanumeric characters only allowed. First Name of Individual
Contact being added to the Provider Organization. |
Yes |
Individual Contact
Middle Name |
Free-text field
and has no default value. Maximum length is 50; Alphanumeric characters
only allowed. Middle Name of Individual Contact being added to
the Provider Organization |
Yes |
Individual Contact
Email |
Free-text field
and has no default value. Maximum length is 100; any character
allowed. Email address of Individual Contact being added to the
Provider Organization. |
Yes |
Individual Contact
Phone |
Area Code: 3
digits. Prefix: 3 digits. Suffix: 4 digits. Individual
Contact Phone Number. |
Yes |
Individual Contact
Phone Extension |
Up
to 7 digits. Individual Contact Phone Number Extension. |
Yes |
Individual Contact
Address 1 |
Free-text field
and has no default value. Maximum length is 55; any character
allowed. Individual Contact Address. |
Yes |
Individual Contact Address
2 |
Free-text field
and has no default value. Maximum length is 55; any character
allowed. Individual Contact Address. |
Yes |
Individual Contact
PO Box |
Free-text field
and has no default value. Maximum length is 55; any character
allowed. Individual Contact PO Box. |
Yes |
Individual Contact
City |
Free-text field
and has no default value. Maximum length is 52; any character
allowed. Individual Contact City. |
Yes |
Individual Contact
State |
State pick list
pre-populated with the state abbreviations. Default = OR. |
Yes |
Individual Contact
ZIP |
Free-text field
and has no default value. Maximum length is 5; numeric characters
only allowed. Individual Contact Zip Code. |
Yes |
Individual Contact
+4 |
Free-text field
and has no default value. Maximum length is 4; numeric characters
only allowed. Individual Contact +4 of Zip Code. |
Yes |
Individual Contact
Facsimile |
Area Code: 3
digits. Prefix: 3 digits. Suffix: 4 digits. Individual Contact
Facsimile. |
Yes |
Individual Contact
Facsimile Extension |
Up to 7 digits.
Individual Contact Facsimile Extension. |
Yes |
