Download CoCASA Software Application

Comprehensive Clinic Assessment Software Application (CoCASA) 7.0 Instructions Guide for Immunization Service Contractors February 6, 2012 The Comprehensive Clinic Assessment Software Application (CoCASA) is a Centers for Disease and Prevention (CDC) software tool used for assessing immunization practices. Data gathered from assessments of providers are used to improve immunization coverage and standards of practice. The following instructions outline the process to download and utilize the CoCASA software application consistent with the Iowa Department of Public Health, Immunization Program assessment standards. Download CoCASA Software Application To download the 2012 version of CoCASA; log onto http://www.cdc.gov/vaccines/programs/cocasa/default.htm and follow CDC s directions for installing CoCASA. If you have any problems downloading, contact the CDC CoCASA Help Line at 1-800-803-5212 or email at nipcocasa@cdc.gov. CDC has a user friendly CoCASA tutorial that is available at the following web site: http://www.cdc.gov/vaccines/programs/cocasa/users-guide.htm CDC periodically updates CoCASA with new or enhanced functionality. It is important to annually update your computer with the most recent version of CoCASA. The current version is 7.0. Page 1 of 22

The first time downloading and opening CoCASA, you may be prompted to browse for an existing database or open CoCASA with a blank database. After selecting a database, the first time CoCASA user will be prompted to register. Enter in your name, initials and zip code in User Profile window. You will also have the option for creating a password to access CoCASA, but this is not required. When you have completed entering the User Profile information, select the OK button. Page 2 of 22

To Begin Using CoCASA Save the data file which has been emailed from the Immunization Program to the desktop or to a shared drive on the office computer where you can retrieve the file to import into CoCASA. To begin using the CoCASA software, locate the CoCASA icon on the desktop it. The CoCASA Welcome Screen will appear. and double click on The next screen that will appear is the User Profile/Login screen. First time users to the application need to create a New log in profile that will be used each time you log into the CoCASA application. Select the New button to set up your user profile. Click Log On button to bring up the CoCASA software. Page 3 of 22

Once you are logged into the application, CoCASA contains five section/tabs of information. o Provider Setup This is the main screen and the first screen that must be used when entering a new provider into CoCASA. Provider Setup allows you to either edit established providers/clinics in CoCASA or enter a new provider/clinic. This information will be provided upon import of your CoCASA data file from the Immunization Program. o Assessment Setup The Assessment Setup screen is comprised of five sub tabs which collect information to establish the criteria for the assessments. This screen is where criteria for AFIX assessments are entered and stored for each provider or clinic site. From this tab, the user is able to add, mark for deletion, copy or change an assessment. o Data Entry The Data Entry tab provides the user the ability to enter data for only the assessment factors selected during the assessment setup. Assessment factors cannot be changed from the Data Entry tab. The user has the capability to add notes for every page (tab) in the Data Entry section of the application. Additionally, the user has the ability to add a patient and change or delete data entered on the screens. o VFC/AFIX Evaluation The VFC-AFIX Evaluation screen is used to enter all VFC and AFIX information collected from site visits or other contact made to enrolled VFC providers. o Reports The Reports tab provides options to run a variety of reports and lists to help users manage VFC and AFIX program activities. Page 4 of 22

Importing Data into CoCASA The Immunization Program will extract the clinic data from IRIS for the age cohorts that will be assessed. This data will be formatted into a useable CoCASA data file that will be emailed by the Immunization Program, to the Program Director identified in the contract. To import this data into CoCASA, go to File on the menu, select Import, then select CoCASA data. Select the location of the file to be imported from. This is the location where the emailed file was previously saved (e.g. desktop or other drive). Select the file you want to import (e.g. P01001-2012 ISC CoCASA Data.xml) and click on the Open button. Progression of the import will appear at the bottom of the screen. When the import is completed you will receive the Import CoCASA Data results screen as shown below. Click OK and CoCASA will return you to the main CoCASA screen. Page 5 of 22

Setting Up Assessment Data in CoCASA Iowa Department of Public Health Select the Assessment Setup tab. The Setup Criteria details provide information about the specific assessment selected. The Setup Criteria is pre-populated by the imported data file extracted from the Immunization Registry Information System (IRIS). Select the desired age cohort from the Setup Criteria tab. The antigens for each age cohort need to be selected. The following is the suggested antigen order which is the same antigen order that is used for the Master Index Card and Certificate of Immunization. From the Antigens tab the antigens can be arranged in the following order. 1 and 2 year-olds: o DTaP o Polio o Hep B o Hib o MMR o Varicella o PCV o Other vaccine types imported from IRIS Adolescents: o Hep B o Meningococcal o MMR o Varicella o Td/Tdap o HPV o Other vaccine types imported from IRIS Page 6 of 22

To move the antigen into the desired order, highlight the antigen and click the move up or move down button until it is in the proper order. If an antigen is missing from your list on the left you can select the antigen from the ACIP recommended antigens on the right, and then use the arrows to move the antigen to your list on the left. For each age cohort that the Moved or Gone Elsewhere (MOGE) status field option is not available, go to the Assessment Setup tab. With the age cohort selected, choose the Assessment Factors tab. Under Choose Patient Status Fields scroll down and check Moved or Gone Elsewhere (MOGE) box. Page 7 of 22

Reviewing Data Entry The Data Entry tab is where you will make updates to Patient Demographics, Patient s immunization history, deleting patient records, or to MOGE a patient record. Note: Any changes to Patient data in the CoCASA application will not be updated in the Immunization Registry (IRIS). Please be sure to update IRIS to permanently save the patient record. The Patient Demographics tab provides the demographics on the selected patient. This tab also provides the Moved or Gone Elsewhere (MOGE) status field. If the patient has met the MOGE criteria (see MOGE Definition) after review of the patient s medical record, select YES from the drop down menu options. The date field will then become active which will allow you to enter the date of the MOGE as recorded from the patient s medical record. Refer to the Moved or Gone Elsewhere (MOGE) Definition located in Appendix A. Selecting Yes from the dropdown will produce a date field to indicate the date of the MOGE. See MOGE Definition The Immunization History tab provides the immunization history from IRIS of the selected patient. The antigen setup screen is viewed top-to-bottom. This is the default and preferred view. You must scroll from top to bottom to view each antigen on the immunization record. If there is a need to change the view of immunization history to view left-to-right, the Brand Name column will be lost and only dates Page 8 of 22

will be displayed. To change the immunization history view, go to Assessment Setup, Antigens tab and change Yes to No under Record vaccine brand names. Scroll down to view other antigens. If a patient s medical record has documentation of immunity to Varicella and is documented in IRIS, this data will be pulled from the registry and pre-populated in the Reasons Not Given tab of the selected patient. If the immunity to Varicella was not marked in IRIS the immunity to Varicella will need to be documented in CoCASA on the selected patient and should be entered into IRIS. Select the Reasons Not Given tab. Enter the date of the documentation from the patient s chart, select Varicella from the drop down menu in the Vaccine Not Given column, then select History of Varicella (chicken pox) from the drop down menu in the Reason Not Given column. If a patient s immunization history is not complete and you need to add an antigen date that is not listed in CoCASA, enter the missing antigen date in the next available antigen date field. Once the cursor moves out of the date field to the next field a Doses Re-Order box appears. With the Re- Order option already selected, click the OK button for CoCASA to re-sort the antigen dates in date Page 9 of 22

order given. Note that any changes to vaccine history made in CoCASA will need to be made in IRIS as well. Add date in next available field. Click OK to re-sort the vaccine date order. Deleting a patient record from the assessment data can only be done if one of the following criteria is met. This does not apply when assessing records not in an immunization home (orphaned record) in your county. o If the patient is seen in the clinic for the first time after 24 months of age (review of the patient s medical record is needed to determine this), the patient will not be included in the assessment and can be deleted from CoCASA. o If the patient has only been seen in the clinic for flu or travel vaccine(s) (review of the patient s medical record is needed to determine this), the patient will not be included in the assessment and can be deleted from CoCASA. To delete the patient record from the CoCASA assessment, choose the name of the patient to be deleted, and then click on the Delete button. A red X will appear to the left of the patient name and the patient information will not be included in the assessment calculations. Highlight the patient record to be deleted and select the Delete button. Page 10 of 22

CoCASA Reports In 2012 if childhood assessment was selected as your objective you will begin assessing patients who were born in 2010 and have reached 1 year of age by December 31, 2011 and children who were born in 2009 and have reached 2 years of age by December 31, 2011. In addition, if adolescent assessment was selected as one of your objectives you will be assessing adolescent patients who were born between 1996-1998 and have reached 13-15 years of age by December 31, 2011. CoCASA Reports are generated from the Reports tab for the provider selected. Select Summary Report to bring up the Standard Report Criteria in this area. Once provider and assessment are selected (if more than one assessment displays in the Choose an Assessment window, select the appropriate assessment) click on the Summary Report shown on the Standard Reports tab. The Please Choose a Report screen will display the Standard Report Criteria options for each type of report selected. In order to create assessment reports you will need to set up the report criteria for each age cohort and series that is being assessed. The criteria is saved once and selected from the My Saved Criteria drop down after selecting the report you want to create. The following pages will explain what the criteria will be and what reports are used for each age cohort. Page 11 of 22

Setting Up Report Criteria for 1 and 2 Year Old Children To assess 1 and 2 Year Olds for 2011 use the same report criteria. Follow the steps below to set up the criteria. o Set the Age Range from 24 to 35 Months option and enter in the As of the previous years ending date (e.g. 12/31/2011). o Next select the 4-3-1-3-3-1-4 (4 DTaP, 3 Polio, 1 MMR, 3 Hib, 3 Hep B, 1 Var, 4 PCV) Series from the dropdown menu. o Next under Compliance select By Age option and enter in 24 then select Months. o Under Set Additional Criteria select both the Apply ACIP Recommendations and Apply 4 day grace period options. o Under Immunization opportunity missed select On any previous immunization visits from the dropdown menu. The format when naming the criteria is Year, series followed by type of assessment (e.g. 2012-4-3-1- 3-3-1-4 by 24 mo). The criteria will need to be saved only once then it will be available for any report needed for that age cohort. Click the Save Criteria button to give your report a name using the format series and type of assessment. (e.g. 2012-4-3-1-3-3-1-4 by 24 mo) Then click the Save button to save the criteria for the series needed when assessing 1 and 2-year-old children in 2012. Click Save Criteria to name your criteria using the format year followed by series type. Page 12 of 22

Reports Available for 1 and 2 Year Old Children Some or all of the following reports may be used in assessing the 1 and 2 Year Old Age cohorts. These reports can be found under Lists on the left hand side of the screen. All these reports can be generated using the 2012-4-3-1-3-3-1-4 by 24 mo criteria under My Saved Criteria. o Late Up To Date A patient name would appear on this report if any assessed immunization was given after 24 months of age. o Missing Immunization This report is used if any numbers appear in the Immunization NOT Complete box on the flow chart. o Last Visit< 12 Months This report lists children in this site who are not up to date and HAVE been immunized in the past 12 months. o Last Visit >=12 Months This report lists children in this site who are not up to date and HAVE NOT been immunized in the past 12 months. o Missed Opportunities This is a list of children in the site who are not up to date and who have, for whatever reason, not received a vaccine that could have been given during a visit. Some children names could be listed more than once if their individual immunization history shows that the missing immunizations could have been given at the time of another immunization visit. This report is only useful in conjunction with the Missing Immunizations and the Individual Immunization History reports. o Invalid Doses This report points out which vaccines are not compliant. The ACIP recommendation is an automatically chosen field when this report is chosen. However, the 4 day grace period is not automatic and needs to be selected. If not checked it includes immunizations that qualify for the grace period. Under the Diagnostic Reports o Single Antigen Report Childhood using the 2012-4-3-1-3-3-1-4 by 24 mo criteria under My Saved Criteria. o Immunization Histories List - This report lists all names and dates of immunizations. This report is useful if you have <50 patients to check immunization dates. o Individual Immunization History - This report lists all names and dates of immunizations. If you have>50 patients use this report which is found under Other Standard Reports. This report shows the antigens in alphabetical order. Page 13 of 22

Setting Up Report Criteria for Adolescents To set up the adolescent assessment criteria select Diagnostic Reports, and then choose Adolescent Coverage. The following Report Criteria is used in the adolescent assessment; o Set the Age Range from 156 to 191 then choosing Months option and enter in the As of the previous years ending date (e.g. 12/31/2011). o Set up the Antigens by clicking on the Antigens button. In the Antigens and Doses wizard enter the following doses for the antigens being assessed. Adolescent Series is 3 Hep B, 1 Meng, 2 MMR, 1 Td, 2 Var, 1 Tdap, 3 HPV o Set the Compliance by selecting By Date option and enter in the previous years ending date (e.g. 12/31/2011). o Under Additional Criteria select Apply ACIP Recommendations and the Apply 4 day grace period options. o Under Immunization Opportunity Missed select On any previous immunization visit from the drop down menu. o Click Save Criteria button and name the criteria as 2012-Adolescent. Adolescent Missing Immunization Report HPV vaccine cannot be selected simultaneously with other antigens since the denominator for HPV includes only females. You will need to set up one other report criteria for the Adolescent Missing Immunizations report. o Select Lists and then choose Missing Immunizations from the type of reports. o Under Make a selection select option for Missing any doses (third option) o Set the Age Range from 156 to 191 then choosing Months option and enter in the As of the previous years ending date (e.g. 12/31/2011) if not already set. o Set up the Antigens by clicking on the Antigens button. In the Antigens and Doses wizard enter 3 HPV. All other antigens will become grayed out. o Under Additional Criteria select Apply ACIP Recommendations and the Apply 4 day grace period options. o Click Save Criteria button, name the criteria as 2012-Adolescent-HPV. Reports Available for Adolescents o Adolescent Coverage found under Diagnostic Reports using the 2012-Adolescent criteria under My Saved Criteria. o Missing Immunizations found under Lists using the 2012-Adolescent criteria under My Saved Criteria. Please be aware under the list of antigens HPV will not be listed, the Missing Immunizations report for HPV is available by selecting the 2012-Adolescent-HPV criteria under My Saved Criteria. Then under Make a selection select option for Missing any doses (third option) before running the report. o Invalid Doses This report points out which vaccines are not compliant. The ACIP recommendation is an automatically chosen field when this report is selected. However, the 4 day grace period is not automatic and needs to be selected. If not checked it includes immunizations that qualify for the grace period. Invalid Doses is found under Lists using the 2012-Adolescent criteria under My Saved Criteria. (Note under Antigens, HPV will not be listed on this report) If Invalid Doses for HPV is preferred use the 2012-Adolescent- HPV criteria under My Saved Criteria. Page 14 of 22

Appendix A Iowa Department of Public Health Immunization Program Immunization Assessment Definition Moved or Gone Elsewhere (MOGE) January 2010 The Iowa Department of Public Health, Immunization Program, will utilize the following definition to document patients that have moved or gone elsewhere (MOGE) for immunization services when conducting an immunization assessment. The MOGE definition has been adapted from guidelines established by the Centers for Disease Control and Prevention (CDC). Moved or Gone Elsewhere (MOGE). A patient that no longer receives immunization services from a healthcare provider due to one of the following: o o o o o The patient s medical record was transferred to another healthcare provider A letter or documented phone call from another healthcare provider that states the patient is under their care Patient or guardian states that the patient is now being seen by another provider for immunization services Clinic s reminder/recall notice is returned with a forwarding address outside of the clinics service area Patient is lost to follow-up. A minimum of 3 separate attempts, using 2 different methods of contact, must be documented (e.g., letter, phone call, home visit, etc.) At least one of the above must be documented in the patient s medical record and include the date(s) of the event(s). Documentation of multiple missed appointments is not adequate to meet the MOGE definition. Page 15 of 22

Appendix B Iowa Department of Public Health CoCASA Algorithm Reference This document describes the algorithms that CoCASA uses to produce reports. If Apply ACIP Recommendations is not checked on the report criteria screen when the report is run, every dose is considered valid and a dose count is the only thing that determines whether or not the patient is complete and up to date for an antigen. Otherwise the rules listed below are applied for each antigen. Unless otherwise noted, the following definitions apply to all of the algorithms: Complete and Up To Date: The patient has received all of the selected vaccinations by either the compliance date if you choose compliance by a specified age (e.g., 24 months), or the compliance age as chosen by the user. If, when using compliance age, the patient s date of birth causes his/her compliance age to fall after the assessment date, the patient is not included in the report, even if he/she falls within the age range chosen for the report. In other words, any patients having not yet reached that age at the assessment date will be excluded from the report. Complete But Late Up To Date: The patient is not up to date at the compliance date or the compliance age requested for the report, but he/she becomes up to date according to the rules of the algorithm between the compliance date/age and the assessment date. Bring Up To Date with One Visit: The patient is not currently up to date by the assessment date, but is one dose shy of being complete for the particular antigen in question. If a report is run against a series of antigens and all of the remaining vaccinations could be given on the same day, then the patient could still be brought up to date with one visit. Missed Opportunity On the Last Immunization Visit: On the patient s last visit for an immunization he/she received a dose of a different antigen than the antigen in question, or there was a reason a different antigen was not given, and at the time of that visit a valid dose of the antigen in question could have been administered in keeping with the patient s age and the time interval from the previous valid or invalid dose. Missed Opportunity On All Immunization Visits: During any of the patient s immunization visits he/she received a dose of a different antigen than the antigen in question, or there was a reason a different antigen was not given, and at the time of that visit a valid dose of the antigen in question could have been administered in keeping with the patient s age and the time interval from the previous valid or invalid dose. Missed Opportunity On All Previous Visits: During any of the patient s visits, not just immunization visits, he/she received a dose of a different antigen than the antigen in question, or there was a reason a different antigen was not given, or there was a non-immunization visit of some kind, and at the time of that visit a valid dose of the antigen in question could have been administered in keeping with the patient s age and the time interval from the previous valid or invalid dose. Dates when only Influenza was given are not considered as a Missed Opportunity for other antigens. Page 16 of 22

Missed Opportunity On Only Non-Immunization Visits: During any of the patient s non-immunization visits, a valid dose of the antigen in question could have been administered in keeping with the patient s age and the time interval from the previous valid or invalid dose. Eligible for Immunization: Those patients who are not complete and up to date as of the assessment date and have no missed opportunities and, based on the rules of the antigen in question, could receive a valid dose of that antigen at the assessment date. Last Visit < 12 Months Ago or Last Visit >= 12 Months Ago: Only patients who are eligible for immunization are counted in these totals. Both immunization visits and non-immunization visits are counted. Note: When running reports, the user can choose more or fewer than the number of doses required by the algorithm for completeness. CoCASA will count the patient as complete for that particular antigen based on the lesser of the dose counts. For instance, if the algorithm requires 5 doses of an antigen, but the user chooses 2, then the patient will be counted as complete with 2 doses. Conversely, if the algorithm requires 2 doses but the user chooses 5, then the patient will still be counted as complete with 2 doses. Also note that when ACIP recommendations are applied, the intervals for compliance, missed opportunities, eligibility, and for coming due are calculated from the last valid or invalid dose. DTaP o Dose 1 must be given at 6 weeks or later. o Dose 2 must be given at 10 weeks or later and at least 4 weeks after dose 1. o Dose 3 must be given at 14 weeks or later and at least 4 weeks after dose 2. o Dose 4 must be given at 12 months or later and at least 6 months after dose 3. o Dose 5, if given, must be given at 4th birthday or later and at least 6 months after dose 4. Note: DTaP, DTP and DT are all valid substitutes for DTaP. o 4 valid doses were given and dose 4 was given on or after the 4th birthday or o 5 valid doses were given and dose 4 was given before the 4th birthday. If ACIP recommendations are NOT applied, CoCASA will count a patient as complete and up to date if: o 5 doses were given. Hepatitis A o Dose 1 must be given at 1 year or later. o Dose 2 must be given at 18 months or later and at least 6 months after dose 1. o there is a reason not given entry before the compliance date that specifies, Lab Evidence of Positive Serology, or MD Diagnosis of Previous Disease as the reason not given or o 2 valid doses were given. o 2 valid doses were given. Page 17 of 22

Hepatitis B o Dose 1 can be given at birth. o Dose 2 must be given at 4 weeks or later and at least 4 weeks after the previous dose. o Dose 3 must be given at 24 weeks or later and at least 8 weeks after the previous dose. Dose 3 must also be given at least 16 weeks after dose 1. o Dose 4, if given, must be given at 24 weeks or later and at least 16 weeks from dose 1. There is no minimum interval between dose 4 and the previous dose. o there is a reason not given entry before the compliance date that specifies, Lab Evidence of Positive Serology, or MD Diagnosis of Previous Disease as the reason not given or o 3 valid doses were given. o 3 valid doses were given. HIB o Dose 1 must be given at 6 weeks or later. o Dose 2 must be given at 10 weeks or later and at least 4 weeks after dose 1. o Dose 3 must be given at 14 weeks or later and at least 4 weeks after dose 2. o Dose 4 must be given at 12 months or later and at least 8 weeks after dose 3. o the patient s age at compliance date was greater than 59 months or o the patient has 4 valid doses or o the patient s first valid dose given after 15 months of age or o the patient s first two doses were given after 12 months of age and dose 2 was given more than 8 weeks after dose 1 or o the patient s third valid dose was given after 12 months of age and it was given more than 8 weeks after dose 2. o 4 doses were given. HPV o Dose 1 must be given at 9 years of age or later. o Dose 2 must be given at 9 years plus 4 weeks of age or later and at least 4 weeks after dose 1. o Dose 3 must be given at 9 years plus 16 weeks of age or later and at least 12 weeks after dose 2 and at least 24 weeks after dose 1. Note: If a user selects HPV on a report (with the exception of the Adolescent Coverage Report), the report will be limited to female patients only. o 3 valid doses were given. o 3 valid doses were given. Page 18 of 22

Influenza For validity (if ACIP recommendations are applied; otherwise all doses are valid). o Doses must be given between September 1 and April 30 to be valid. o Dose 1 must be given at 6 months or later. o Dose 2, if required, must be given at 6 months plus 4 weeks or later and at least 4 weeks after dose 1. o 1 dose was given within the influenza season and either the patient was 9 years of age or more at the time of the dose or it was not the first dose of life or o 2 doses were given in a season and dose 1 was the first dose of the patient s life and the patient was less than 9 years of age at the time of dose 1. o 2 doses were given. MMR o Dose 1 must be given at 12 months or later and cannot be given within 1-27 days after receiving varicella, smallpox, laiv (Flumist), yellow fever, monovalent measles, mumps or rubella. o Dose 2 must be given at 13 months or later and at least 4 weeks after dose 1 and cannot be given within 1-27 days after receiving herpes zoster (shingles), varicella, smallpox, laiv (Flumist), yellow fever, monovalent measles, mumps or rubella. o there is a reason not given entry before the compliance date that specifies, Lab Evidence of Positive Serology, or MD Diagnosis of Previous Disease as the reason not given or o the patient was born before 1957 and is not a health care worker or o the patient was born during or after 1957, or is a health care worker, and 2 valid doses were given. o 2 doses were given. Meningococcal o Dose 1 must be given greater than or equal to 2 years of age. Any dose after the first dose must be given at least 5 years after any previous dose. o there was at least one valid dose of any variety of meningococcal given on or after the 11th birthday or o the patient has no risk factors and the compliance date is on or after the 2nd birthday and before the 11th birthday (risk factors are asplenia, terminal complement component deficiency, military recruits of the U.S., contacts in a meningococcal outbreak, travel (internationally) to a risk area, lab exposure to meningococcal, and college student in dormitory) or o the patient has a risk factor, the compliance date is on or after the 2nd birthday and the patient was given at least 1 dose of meningococcal. Page 19 of 22

o 1 dose was given. Pneumococcal Conjugate Vaccine (PCV) o Dose 1 must be given at 6 weeks or later. o Dose 2 must be given at 10 weeks or later and at least 4 weeks after dose 1. o Dose 3 must be given at 14 weeks or later and at least 4 weeks after dose 2. o Dose 4 must be given at 12 months or later and at least 8 weeks after dose 3. o the patient s age was greater than 59 months at the compliance date or o 4 valid doses were given or o the patient s first valid dose given after 24 months of age or o the patient s first two doses were given after 12 months of age and dose 2 was given more than 8 weeks after dose 1 or o the patients third valid dose was given after 12 months of age and it was given more than 8 weeks after dose 2 o 4 doses were given. Polio o Dose 1 must be given at 6 weeks or later. o Dose 2 must be given at 10 weeks or later and at least 4 weeks after dose 1. o Dose 3 must be given at 14 weeks or later and at least 4 weeks after dose 2. o Dose 4 must be given at 4 years of age or later and at least 6 months after dose 3. o 3 valid doses were given and the 3rd dose was given on or after the 4th birthday or o 4 valid doses were given. o 4 doses were given. Pneumococcal Polysaccharide Vaccine (PPV) o Dose 1 must be given at 2 years or later. o Dose 2, if given, must be given at 7 years or later and at least 3 years after dose 1 if the patient is under 10 years of age at the time of the second dose, or at least 5 years after dose 1 if the patient is 65 or older at the time of the second dose. o the patient was greater than or equal to 2 years of age and less than 65 years of age at the compliance date and had no risk factors (heart disease; lung disease chronic, not asthma; sickle cell disease; diabetes mellitus; alcoholism; liver disease chronic or cirrhosis; Hodgkins disease; renal disease/nephrotic syndrome; asplenia; organ transplant; lymphoma; leukemia; HIV Page 20 of 22

infection; steroids, long term; radiation therapy; cancer drugs; American Indian or Alaskan Native) or o 1 valid dose was given and the patient was greater than 10 years of age and less than 65 years of age at the compliance date and had a risk factor or o 2 valid doses were given and the patient was less than 10 years of age at the compliance date and he/she had a risk factor or o 1 valid dose was given and the patient was over 65 years of age at the time of the first dose or o 2 valid doses separated by 5 years were given and the patient was under 65 years of age at the time of the first dose and was over 65 years of age at the compliance date. o 2 doses were given. Rotavirus o Dose 1 must be given at 6 weeks or later. o Dose 2 must be given at 10 weeks or later and at least 4 weeks after dose 1. o Dose 3 must be given at 14 weeks or later and at least 4 weeks after dose 2. o the patient was greater than or equal to 32 weeks of age at the compliance date or o 3 valid doses were given. o 3 doses were given. Td o Dose 1 must be given at 7 years or later. o Dose 2 must be given at 7 years or later and at least 4 weeks after dose 1. o Dose 3 must be given at 7 years or later and at least 6 months after dose 2. o Boosters after dose 3 must be given at least 5 years after the previous dose. Note: TDaP is a valid substitute for Td, except on the Adolescent Coverage Report. CoCASA will count a patient as complete and up to date if: o at least 3 valid doses were given and at least 1 valid dose was given sometime in the ten years prior to the compliance date (even if ACIP recommendations are not applied). Tdap o Dose 1 must be given at 10 years of age or later. o 1 valid dose was given. o 1 valid dose was given. Page 21 of 22

Varicella o Dose 1 must be given at 12 months or later and cannot be given within 1-27 days after receiving herpes zoster (shingles), MMR, smallpox, laiv (Flumist), yellow fever, monovalent measles, mumps or rubella. o Dose 2, if required, must be given after 12 months plus 90 days and at least 90 days after dose 1 if the patient was under 13 years of age at the time of dose 2, or at least 28 days after dose 1 if the patient was greater than or equal to 13 years of age at the time of dose 2. Dose 2 cannot be given within 1-27 days after receiving herpes zoster (shingles), MMR, smallpox, laiv (Flumist), yellow fever, monovalent measles, mumps or rubella. o there is a reason not given entry before the compliance date that specifies History of Varicella, Lab Evidence of Positive Serology for Varicella, or Parent/Patient Report of Disease as the reason not given or o 2 valid doses were given. o 2 doses were given. This document can be found on the CDC web site at: http://www.cdc.gov/vaccines/programs/cocasa/downloads/algorithm_reference_document.pdf Page 22 of 22