Provider Demographics List

Purpose

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

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.