Provider Demographics List

 Purpose

 The Provider Demographics List is used to pull Organization information for the “Primary Registry” and “Primary Inventory” Contact Roles.

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 Provide Demographics List Report

The report output will be an Excel file containing the field names below:

 

Field Name

Description

TXIIS ID

 Organization's ImmTrac2 ID.

Org Name

 Name of the organization.

Org Physical Address 1

 Physical Address Line 1 of the organization

Org Physical Address 2

 Physical Address Line 2 of the organization

Org City

 The city where the organization is located.

Org State

 The State where the organization is located.

Org Zip

 The 5-digit zip code where the organization is located.

Org Zip +4

 The 4-digit extension zip code where the organization is located.

Org Type

 The type of organization.

Org Intent

 The type of clients the organization serves.

LHD Selection

 The Local Health Department the organization belongs to.

Region Selection

 The Health Service Region the organization falls under.

Org County

 The County the organization falls under.

Responsible Entity

 State-defined region the organization is assigned/associated to.

VFC PIN

 State supplied Vaccines for Children PIN for the organization.

VFC Status

 The VFC status of the organization.

Site Registration Date

 The date the initial site agreement was signed.

Site Agreement Date

 The date of the most recent site agreement.

Primary Registry Contact Last Name

 Last Name of the Primary Registry Contact.

Primary Registry Contact First Name

 First Name of the Primary Registry Contact.

Primary Registry Contact E-mail Address

 E-mail address listed for the Primary Registry Contact.

Primary Inventory Contact Last Name

 Last Name of the Primary Inventory Contact.

Primary Inventory Contact First Name

 First Name of the Primary  Inventory Contact.

Primary Inventory Contact E-mail Address

 E-mail address listed for the Primary Inventory Contact.

 

Note:

  1. If no contact information is supplied the contact fields in the output file will display as blank.
  2. If there are more than two contacts listed for the organization, the first two Primary Registry or Inventory contacts will be included in the report.