Hospital Survey

The Hepatitis B Birth Dose Program funded through 317 federal funds will be sunsetting this fall. Hepatitis B vaccine and Nirsevimab are available to eligible infants through the Vaccines for Children (VFC) Program.

Please complete this survey. Within the survey hospitals can express interest in the VFC Program. A Regional Immunization Nurse will arrange an in-person visit and provide more details on the VFC Program and help support the change from the 317 funded program to the VFC Program.
1.Provider Name(Required.)
2.Provider PIN
3.Contact Person Name(Required.)
4.Contact Email(Required.)
5.Phone Number(Required.)
6.Is your facility currently enrolled in the Hepatitis B Birth Dose Program?(Required.)
7.Would your facility be interested in learning more about the Vaccines for Children Program?(Required.)
8.If your facility is interested, what Electronic Health Record is currently being used?