Skip to content
Hepatitis A EMS Immunization Program Interest Survey
1.
Contact Information
Name of Person Completing the Survey
EMS Agency
County
Email Address
Phone Number
*
2.
Is your organization interested in starting a Hepatitis A immunization program?
(Required.)
Yes
No
Need more information
*
3.
What type of EMS Immunization Program are you considering starting?
(Required.)
EMS Community Paramedicine Immunization Programs:
These programs perform vaccination clinics in the community events such as footballs games, fairs, festivals, etc…..
EMS Community Paramedicine Integrated Into 911 Response Immunization Program:
These programs identify high risks patients during their 911 emergency calls and then send community paramedics to their location to vaccinate soon after the 911 encounter.
EMS/Fire Station Based Immunization Programs:
These programs maintain the vaccine and perform vaccinations on patients that wish to be vaccinated at the EMS/Fire Stations.
911 Response Immunization Program:
These programs carry refrigerated vaccine on 911 responding ambulances and perform vaccinations in non-emergency situations.
Other (please specify)
Current Progress,
0 of 3 answered