COVID-19: Vaccinator Enrollment

On August 11, 2022, Centers for Disease Control and Prevention (CDC) announced it's streamlining its COVID-19 guidance to help people better understand their risk, how to protect themselves and others, what actions to take if exposed to COVID-19, and what actions to take if they are sick or test positive for the virus. DHS is currently reviewing CDC updates and will update our guidance accordingly.

Wisconsin COVID-19 Vaccine Program is continuing to enroll entities that wish to administer COVID-19 vaccine in Wisconsin. This page delineates the steps and other information needed to enroll in the program and get approved to administer COVID-19 vaccine in Wisconsin. To become a COVID-19 vaccinator, all organizations must have an approved Form A, Form B, and Redistribution Form. See the general vaccination guidance page for steps to redistribute vaccine.

Updates  
  • DHS encourages vaccinators to review the required and recommend trainings and information below or on this printable document. Enrolled providers who are just beginning to vaccinate children under 11 years must fill out the Pediatric (6 months – 11 years) Vaccination Training Attestation Survey. However, providers who have already attested to completing the trainings for vaccinating youth 5–11 years do not need to complete any additional attestations.
  • Guidance for pharmacists vaccinating children under 6 year is in the section below on providers eligible to administer COVID-19 vaccine.
  • Effective 2022, Wisconsin Department of Health Services is now requiring an approved Redistribution Form for all COVID-19 vaccine provider organizations. See the vaccine redistribution and transfer guidance on how to fill out a Redistribution Form and transfer vaccine.

Useful links and resources

Monthly webinars

Webinars for stakeholders and vaccinators are held the second Tuesday of every month from 11 a.m. to noon. The Zoom link for the webinar has not changed.

New attendees need to register for this webinar. Once you register, you can use the same Zoom link for every webinar.

Watch recordings of past webinars.

Requirements to administer COVID-19 vaccines

Providers eligible to administer COVID-19 vaccine

Pharmacists vaccinating children under 6 years

For a pharmacist to administer a COVID-19 vaccine to a child under 3 years of age, the child/patient must have a prescription issued by a health care provider in the previous 29 days. This applies regardless of the provider location (for example pharmacy, physician’s office, mobile clinic) where the child is receiving the vaccine.

Under the Public Readiness and Emergency Preparedness (PREP) Act, pharmacists may vaccinate individuals 3 years and older with the COVID-19 vaccine without a prescription. However, if the pharmacist is following the Wisconsin Statue 450.035 and not using the PREP Act, the pharmacist will need a prescription issued in the last 29 days to vaccinate children aged 3-5 years. No prescription is needed to vaccinate people ages 6 years and older.

Pharmacies will vary in the ages that they are vaccinating, so it will be important if you are referring patients out to be sure the referring entity is vaccinating that age.

For more information on federal actions and Wisconsin law allowing pharmacy vaccination of younger children, see Dr. Westergaard's memo on COVID-19 Vaccination for Wisconsin’s Youngest Children.

Standing prescription order for COVID-19 vaccines

The Standing Prescription Order for COVID-19 Vaccines authorizes personnel to administer COVID-19 vaccine and highlights requirements related to patient eligibility, staff training, and an appropriate plan of care.

The revised standing order enables Emergency Medical Services (EMS) providers and practitioners to administer COVID-19 vaccine, providing an opportunity for more partnerships at the local level that increase the capacity of vaccinators to meet community demands. For a more thorough overview, see the bulletin about the revised standing order.

Vaccinators who are interested in engaging with local EMS are encouraged to reach out to their local EMS contacts directly to explore potential support and to collaborate with LTHDs to ensure all vaccinating partners are aware of local capacity.

Providers eligible to administer COVID-19 vaccine through guidance under the PREP Act

Joint guidance on the Public Readiness and Emergency Preparedness (PREP) Act March 11, 2021 Seventh Amendment was issued from:

  • Wisconsin Department of Health Services (DHS)
  • Wisconsin Department of Safety and Professional Services (DSPS)
  • Wisconsin Veterinary Examining Board (VEB)

Licensed health professionals or other individuals authorized by the state of Wisconsin may administer COVID-19 vaccines. Providers should always consult their governing laws and any policies or guidance issued by the regulatory program, board, or commission for their profession, as well as the Declaration under Public Readiness and Emergency Preparedness Act for Medical Countermeasures Against COVID-19, referred to as the “PREP Act of 2020.” Providers are responsible for complying with the standards of practice and any other legal requirements applicable to their profession when ordering or administering vaccines in Wisconsin. Please refer to the DSPS for additional information.

In addition to licensed health professionals or other individuals authorized by the state of Wisconsin, through the PREP Act Declaration, the federal government has provided a pathway for state, local, territorial, and tribal (SLTT) governments to rapidly expand and support their vaccination workforces as needed. In March 2020, the HHS Secretary issued the PREP Act of 2020 covering COVID-19 tests, drugs, and vaccines providing liability protections to manufacturers, distributors, SLTTs, licensed health care professionals, and others (qualified persons) identified by the U.S. Health and Human Services (HHS) Secretary who administer COVID-19 countermeasures. On March 11, 2021, the HHS Acting Secretary issued the PREP Act Seventh Amendment to extend liability protections to specified health care professionals who may not usually administer vaccines in their scope of practice or who have recently expired licenses, and students of specified health care professions who administer COVID-19 vaccines.

DSPS and DHS have deemed that the following health care professionals who hold an active credential under the law of any state, or hold a credential that has expired, become inactive, or lapsed within the last five years and was in good standing when it expired, lapsed, or became inactive, and who meets all the requirements under the PREP Act Seventh Amendment, are authorized under the PREP Act Seventh Amendment to administer U.S. Food and Drug Administration (FDA) authorized, approved, or licensed COVID-19 vaccines in Wisconsin.

Health professionals (currently licensed, certified, or registered or had active license, certification, or registration within the last five years):

  • Physicians
  • Registered nurses
  • Licensed practical nurses
  • Advanced practice registered nurses
  • Pharmacists
  • Pharmacy interns
  • Midwives
  • Physician assistants
  • Respiratory therapists
  • Dentists
  • Podiatrists
  • Optometrists
  • Emergency medical services providers (EMT, AEMT, EMT intermediate, or paramedic)
All professionals and students

All professionals and students must meet and comply with all applicable requirements outlined in the PREP Act 2020 Declaration and Amendments, as well as any additional training required by the state, territory, locality, or tribal area in which they are prescribing, dispensing, or administering COVID-19 vaccines.

To become a part of the expanded COVID-19 vaccine workforce in Wisconsin, you will need to determine if you meet eligibility requirements and training under the PREP Act of 2020. Subject to certain requirements and if eligible, PREP Act coverage provides liability protections under federal and state/territorial law with respect to all claims for loss resulting from the administration or use of a covered countermeasure in this case COVID-19 vaccine. Some professions may have limitations related to delegation, supervision, training, settings, etc. when ordering or administering vaccines. We encourage providers to consult with their specific program, board, or commission for guidance specific to their profession.

Everyone administering COVID-19 vaccines must complete the DHS required training in the training section below prior to becoming a COVID-19 vaccinator.

Health care students

Students in a medical, nursing, pharmacy, pharmacy intern, midwife, physician assistant, respiratory therapy, dental, podiatry, or optometry training program may also administer FDA authorized, approved, or licensed COVID-19 vaccines in Wisconsin pursuant to the PREP Act Seventh Amendment.

Veterinary students

Students in a veterinary medicine program may also administer FDA authorized, approved, or licensed COVID-19 vaccines in Wisconsin pursuant to the PREP Act Seventh Amendment. Students administering vaccine must have appropriate training in administering vaccines as determined by the student’s school. Students must also be supervised by a currently practicing health care professional with experience in administering intramuscular injections.

Licensed veterinarians

The VEB has deemed all veterinarians licensed by VEB (managed by the Wisconsin Department of Agriculture, Trade, and Consumer Protection), or who has a credential that has expired, become inactive, or lapsed within the last five years and was in good standing when it expired, lapsed, or became inactive, from any jurisdiction, and who meets all requirements under PREP Act Seventh Amendment, as authorized under the PREP Act Seventh Amendment, may administer FDA authorized, approved, or licensed COVID-19 vaccines in Wisconsin if properly trained per DHS requirements.

At this time, DHS is not seeking additional locations to administer the COVID-19 vaccine. Individuals interested in administering vaccine are encouraged to enroll through the Wisconsin Emergency Assistance Volunteer Registry (WEAVR) and indicate their interest in providing COVID-19 vaccine. DHS will query individuals enrolled in WEAVR as additional vaccinators are needed to support on-site clinics.

Required COVID-19 vaccinator trainings for all age populations

All vaccinators ordering, handling, and/or administering COVID-19 vaccines received through the Wisconsin Department of Health Services (DHS), including the primary and back up contacts, must review and understand the following required information and guidelines.

To view this information in a printable format for your internal review see the COVID-19 Vaccinator Training & Readiness Checklist, P-03269.

  • Clinical protocols and administration requirements
  • Vaccine Storage and Handling Requirements
    • Review the CDC's Vaccine Storage and Handling Toolkit, and meet all requirements of the CDC's vaccine storage and handling guidelines.
    • Ensure a written cold chain plan and procedures is in place for receiving, storing, and handling vaccine. This plan should incorporate the most recent guidance from CDC.
    • Ensure all vaccine locations must have the proper storage and handling equipment and temperature monitoring devices. It is necessary to properly maintain temperatures, especially if transporting vaccines to off-site clinics or drive-thru clinics.
    • Manage your vaccine inventory by monitoring expiration dates weekly, rotating stock as needed, and following a “first in, first out” strategy.
    • Check posted manufacturer information for the most up to date expiration/extension information for Pfizer-BioNTech, Moderna, Novavax, and Johnson & Johnson COVID-19 vaccines. Update expiration dates accordingly in WIR.
    • Alert the Wisconsin COVID-19 Vaccine Program at DHSCovidVaccinator@wi.gov immediately if:
      • You are not ready to receive a shipment, require fewer doses, or have any questions about shipment. Please include “Vaccine Shipment” in the subject line.
      • There is any risk of vaccine spoilage or wastage because of low uptake or other reasons. DHS may reallocate the vaccine to other sites.
  • Wisconsin Immunization Registry (WIR) Requirements
    • Review all five online WIR Training Modules.
    • Enter each administered dose into WIR within 24 hours of administration. 
    • If using an electronic health record (EHR), all vaccinators have ensured that the EHR is set up to document COVID-19 vaccine doses and submit patient level data to WIR within 24 hours of administration.
    • Maintain accurate COVID-19 vaccine inventory in WIR, including updating expiration dates and reporting vaccine wastage.
    • Acknowledge that all trained staff are using WIR for COVID-19 vaccine management and reporting of administered doses. It is a critical component of ensuring vaccine coverage and accountability.
  • Vaccination Clinic Planning Requirements
    • Follow the vaccine ordering process steps and be aware of the vaccine ordering amounts and timelines.
    • Use the Wisconsin COVID-19 Vaccine Exchange. This is especially important if you may not be able to use all the vaccine doses before the expiration date or beyond-use date. The recorded webinar from June 8, 2021 includes an overview and background information about the Wisconsin COVID-19 Vaccine Exchange, starting at minute 16:00.
    • Ensure that other parties that you might exchange vaccines with have a Redistribution Form on file. DHS requires all Wisconsin vaccinators to complete a Redistribution Form.
    • Ensure the location’s enrollment paperwork is kept up to date, and that proper paperwork is on file for each location where the vaccine is being stored overnight. Some exceptions may apply; see Provider Registration Scenarios: When to Submit a Form B.
    • Maintain your Vaccines.gov profile and make sure your public display is turned on so the public can find your vaccination site. See more instructions below in Step 7,
    • Assess the following individuals using CDC's Competencies Checklist:
      • Experienced vaccinators
      • Vaccinators who have not administered vaccines in the past 12 months or longer 
      • Medical and administrative support staff who are not licensed to administer vaccines but assist with vaccine preparation and cold chain management
      • Healthcare providers who require documentation of an observation period as part of the Declaration under the Public Readiness and Emergency Preparation (PREP) Act for Medical Countermeasures Against COVID-19
  • Patient Education Requirements
    • Distribute the following to each recipient:
    • Establish a communications plan to remind patients to come back for their next dose.
      • Schedule their next appointment, if possible, and give the patient a note about when to come back for their next dose.
      • Supplement the vaccine appointment note with text messages, phone call, or email reminders.
      • Use Reminder/Recall or Benchmark Report from WIR, or your electronic medical record (EMR), to remind patients when to come back.

Required trainings for vaccinating patients aged 6 months–11 years

In addition to reviewing the required COVID-19 vaccinator trainings for all age populations listed on this webpage, vaccinators are encouraged to review and understand the following required items prior to being able to administer COVID-19 vaccines to patients aged 6 months–11 years.

Enrolled providers who are just beginning to vaccinate children under 11 years must fill out the Pediatric Vaccination Training Attestation Survey. However, providers who have already attested to completing the trainings for vaccinating youth 5–11 years do not need to complete any additional attestations.

  • Ensure the facility has updated vaccination protocols and standing orders in accordance with the:
  • Review the different Pfizer and Moderna COVID-19 vaccine presentations for each age group.
  • Give parents or caretakers the product-specific Vaccine Information Fact Sheet for Recipients and Caregivers (Pfizer or Moderna) prior to their child receiving the COVID-19 vaccine.
  • Update your Vaccines.gov profile to indicate the minimum age of patients eligible for vaccine administration at your vaccination site.
  • Ensure that preparation, considerations, and capabilities for managing anaphylaxis are appropriate for children.
    • Age and size appropriate emergency supplies must be available, including age-appropriate epinephrine dosing and blood pressure cuffs. You must have at least 3 or more doses of epinephrine on hand for each age group that you vaccinate.
    • If your plan is to call 911 as primary support, ensure the responding agencies are equipped, trained, and available to respond in the required time frame to manage adverse reactions in children.
  • Train all vaccinators on your plan for handling adverse events in children. All staff administering vaccines must be prepared to manage anaphylaxis.

See below for further recommended trainings.

Supplemental and recommended trainings

New vaccinators may need additional trainings or to review additional resources to feel comfortable providing the COVID-19 vaccine. The following are recommended for new vaccinators and can be used by experienced vaccinators as a review.

Steps to enroll

It is important that you complete every step in the enrollment process in order to ensure your submission is processed as quickly as possible. Please use Google Chrome or Microsoft Edge when navigating the enrollment tool. Email the Wisconsin Department of Health Services (DHS) if you have any questions.

Step 1: Log in to the COVID-19 Vaccinator Enrollment Tool.

Log in to the COVID-19 Vaccinator Enrollment Tool using your Wisconsin Department of Administration (DOA)/Wisconsin Logon Management System username and password.

  • If you do not have a DOA/Wisconsin Logon, please register here.
    • Select Self-Registration. After you accept the user agreement and fill in your personal profile information, select “DHS Health Reports” under “Systems You Will Access.”
    • After your registration is complete, proceed to the enrollment tool.
  • If you have a DOA/Wisconsin Logon, then proceed to the enrollment tool and logon using your DOA/Wisconsin Logon username and password.
    • If you cannot access your existing account, try using the ‘Forgot username/password’ link below the Log on button to reset the password. Contact DHSCovidVaccinator@wi.gov for assistance if you are unable to reset the password.

Step 2: Generate your forms.

Note: Once information is entered and site type is chosen, you may not go back to change them.

  • Enter information into the COVID-19 Vaccinator Enrollment Tool.
  • Scroll to the bottom of the page and select “Generate Forms,” which will generate forms specifically for your organization.
    • Your organization's legal name and a reference number will be pre-populated on the forms (located at the bottom of each generated form).
    • You can have your vaccine sites use this information to ensure they are using your organization-specific forms.

Step 3: Complete and sign your forms.

Note: All forms should be filled out electronically in Adobe Acrobat Reader DC (the free version is sufficient). All signatures must be present on a form before submission. Instruction is provided within the forms by hovering over the blue bars in the form.

Step 4: Submit all your forms.

Note: You may submit your organization's forms from any DOA/Wisconsin Logon. Only submit the completed forms that were specifically generated for your organization with the reference number in Step 2 above. The reference number is listed at the bottom right of your generated forms.

  • Find “Submit Forms” at the top left of your web browser.
  • Upload your completed and signed forms to their corresponding fields. Please remember to sign and date your forms.
  • Scroll to the bottom of the page and select the “Upload Files” button.
  • If you need to change your information after submitting, do so via the Wisconsin Immunization Registry (WIR). Any information that needs to be changed outside of WIR can be done by contacting DHSCovidVaccinator@wi.gov.

Step 5: Respond to questions about your submission, at all stages of registration.

  • At different stages of registration, DHS may contact you to ask questions about your submission, correct errors, or provide instructions on next steps. Please respond to this outreach immediately so that DHS can continue processing your registration.
  • This step may occur after your organization has been approved to receive vaccine.

Step 6: The primary contact will receive an email from DHS with next steps for your organization.

Once your information is verified and your WIR account is configured, the primary and backup contacts listed on the Form B will receive an email from DHS with next steps for your organization.

Step 7: Once you are enrolled and have ordered COVID-19 vaccine, create a public profile on Vaccines.gov

It is critical that vaccination sites maintain their Vaccines.gov profile. Vaccines.gov is the tool that the public uses to find COVID-19 vaccines near them and other important information including: vaccine type, vaccine stock (based on your vaccine inventory), clinic days and hours, walk-in policy, minimum vaccination age, and additional vaccination site details.

Please refer to the Vaccines.gov provider resources webpage for instructions on managing your profile. Vaccinators should manage the profile for each site:

  • Whether a site is publicly displayed or not
  • Website information
  • Phone number
  • Hours
  • Minimum vaccination age

DHS reports daily inventory data to Vaccines.gov and will continue to provide vaccine type and in stock inventory data on behalf of vaccinators. Please note, Vaccine.gov only displays whether or not vaccine is in stock, it does not display inventory numbers. Vaccinators will not be able to update their inventory settings, location name, or addresses. Vaccinators only need to maintain their profile.

How to get started with Vaccines.gov
  1. After completing enrollment, your location’s organizational contact (as indicated under Form A of the Provider Agreement) should receive an email from vaccinefinder@auth.castlighthealth.com. This email provides instructions to complete the Vaccines.gov registration process using the COVID Locating Health Provider Portal. This invitation will expire after 7 days.
    1. Answers to frequently asked questions and other instructions are available through the Vaccines.gov Provider Resources page.
    2. If you cannot locate the email from vaccinefinder@auth.castlighthealth.com, or you need further assistance after reviewing the guide, please email DHSCovidVaccinator@wi.gov.
  2. The initial registration invitation is sent to the organization email listed under part A of the Provider Agreement. If any of your organization and coordinator emails are incorrect, please email DHS at DHSCovidVaccinator@wi.gov to request any necessary updates.
  3. When you register with Vaccines.gov, you can set up the reporting structure for your organization. There are two options:
    • Under the organizational-level maintenance setup, the Part A contact would be required to manage the details for the public profiles of all locations.
    • If the organization wishes to delegate the control of profile information to each individual location, they should set site-level maintenance:
      • If the organization contact designates site-level reporting, this triggers registration emails to be sent to the site-level vaccine coordinators listed in section B of the Provider Agreement.
      • After registration is completed, the coordinators for each location would be able to login independently and manage details for that specific location.
  4. Once registered in Vaccines.gov, you will be responsible for managing the public display information for your locations on Vaccines.gov through the portal. To begin, check your public display details to make sure the information is accurate.
  5. Providers have the option of uploading a spreadsheet or filling out a manual form to update their public display information. Guides for each option are below:
    • Upload file - typically used by providers who are reporting for a large number of locations.
    • Log manually - typically used by providers who are reporting for a small number of locations.
  6. Please note, vaccinators will not be able to update their inventory settings, location name, or addresses. To make changes to inventory setting, location name, or address please email DHSCovidVaccinator@wi.gov with the subject VACCINES.GOV.
  7. For more information on Vaccines.gov, please see the Vaccines.gov provider resources webpage.
Minimum patient age update

Vaccines.gov has data fields to allow providers to indicate a minimum age of patients eligible for vaccine administration at a given location. This can be reported in months and/or years.

Vaccinators are highly encouraged to update these age fields. These fields can either be updated manually or using the file upload method.

  • If updating a vaccinator profile manually, this information can be entered using two drop-down fields. There is one drop-down field for months, and another drop-down field for years.
  • If updating the vaccinator profile via file upload, there are two new columns available at the end of the file template. The column headers are min_age_months and min_age_years.

Be aware of the following field format requirements for Minimum Age:

  • Minimum Age Months and Minimum Age Years both must be whole numbers. Note that you can only enter a minimum age in months if the age is 24 months or younger.
  • Minimum Age Months and Minimum Age Years are always added together.
    • For example, if the minimum age for a location is 1.5 years, you could enter it in two ways:
      • minimum age months = 18; minimum age years = 0
      • minimum age months = 6; minimum age years = 1
    • Do not enter it this way: minimum age months = 18 and minimum age = years 1.5 as the result will be minimum age displaying as 3 years (18 months plus 1.5 years).
Ensuring your profile is viewable

Vaccines.gov allows vaccinators to customize your site’s visibility. Most sites should be publicly viewable. However, vaccination sites that are not for the general public, such as employer-based clinics, do not need to be publicly viewable.

Your location will be findable on Vaccines.gov if:

Note: only the first 50 results are shown so larger cities may not show all possible locations that match.

Best practices when updating your Vaccines.gov profile

DHS encourages vaccinators to consider the following when updating their public profile.

  • In the “Notes” section:
    • Include information about what accommodations are available for individuals with disabilities and how they can contact your organization in advance.
    • Include information about parking, entrances, and other access details.
    • Include information in Spanish and/or other languages spoken by individuals in your community when possible.
    • Provide information as to whether you are open to partnering with community organizations. For example, “willing to partner for on-site clinics with employer and community organizations.”
  • For single-day or pop-up clinics, please provide information at least three days prior to ensure visibility on the map.
  • You can also add a Vaccines.gov widget to your own webpage to help patients find vaccination locations.

Vaccinators only need to provide public-facing information. DHS is currently reporting daily inventory data from WIR to Vaccines.gov and will continue to provide vaccine type, in-stock inventory data, and site address information on behalf of vaccinators. Therefore, it is very important for all vaccinators to keep their inventory up to date in WIR so the public has current information when choosing a vaccinator. Please note, Vaccines.gov only displays whether or not vaccine is in-stock, it does not display inventory numbers.

Support

The CDC and Vaccines.gov offer several resources for vaccinators. Reviewing the Vaccines.gov COVID-19 Vaccine Provider Process Overview webpage is recommended.

For website errors or changes to inventory, display, location name, appointed coordinators, or posted address, please email DHSCovidVaccinator@wi.gov with the subject Vaccines.gov. A DHS representative will respond within 1-3 business days. If your location is no longer administering COVID-19 vaccines, please contact DHSCovidVaccinator@wi.gov to request inactivation. 

For all other support including password resets, or general account/login-related questions, please contact the Vaccines.gov help desk at 833-748-1979 or email at CARS_HelpDesk@cdc.gov.

Enrollment questions and answers

 Training

For more information about the Wisconsin Immunization Registry (WIR), visit their website or contact the WIR Help Desk by phone 608-266-9691 or email.

Q: Who needs to do the WIR training?

A: With having access to WIR data and ensuring timely and accurate information, comes the need for a solid understanding of how to utilize the various components of WIR and how they work together. Any staff responsible for data entry into WIR for the daily management of inventory and/or updating client (patient) records to record the administered dose are required to review the training material. Staff that are only administering vaccine and will not be responsible for the data entry and management do not need to be concerned with the training.

Q: What does the WIR training entail?

A: WIR training includes the following topics:

  • Client look up and entry of doses, including mass vaccination module

  • Inventory management, including reporting daily inventory

  • Use of bar code scanner

  • Transferring doses

  • Reporting wasted doses

Q: What should I do if I can't access the WIR training related to COVID-19 enrollment?

A: Staff with existing IR Administrator access should be able to use the ‘Assign Training’ tool to provide their staff with the training modules.

If you are using a web browser other than Internet Explorer (IE), you may encounter issues with this.

 General enrollment

Q: How do I enroll?

A: Please follow the steps outlined in the Steps to Enroll tab above. Once you generate your forms in the enrollment tool, there is hover text with additional details located in the blue bars of your forms. When you hover your mouse over some of the blue section bars, text boxes will pop up with further instructions.

Q: Should I enroll in the COVID-19 Vaccine Program if my organization is already a Vaccines for Children (VFC) and/or Vaccines for Adults (VFA) provider?

A: Yes, you need to enroll. This is a new program and all providers need to sign the CDC COVID-19 vaccine agreement regardless of VFC or VFA status. If administering the COVID-19 vaccine children between 6 months through 11 years, you must attest to an additional set of age-specific training certifications listed above. 

Q: Is there a certain web browser I must use for the enrollment tool?

A: Yes, please use Google Chrome. Do not use Internet Explorer or Microsoft Edge. If you do submit your forms in the wrong browser, you may get an error. If this happens, please regenerate the forms and resubmit them in Google Chrome.

Q: Where can I find additional instructions to complete the enrollment forms?

A: Additional instructions are provided as hover text over the blue bars within each of the forms. There are guides on how to fill out all provider enrollment forms in the COVID-19 Vaccine Enrollment Tool. These go over examples and expand on what is needed in each section of the forms.

Q: How do I electronically sign my agreement?

A: Complete the following steps:

  1. Use Google Chrome to download the forms.

  2. Save the forms to your desktop.

  3. Complete your forms electronically in the updated version of Adobe Acrobat Reader DC. If you use an earlier version, it will let you sign and complete your form, but the PDF produced from it may be too large to be accepted by the enrollment tool. Do not complete the forms in a web browser, such as Internet Explorer.

  4. Follow the instructions found in the enrollment tool to upload your forms and complete your signature.

Q: How do I know what the next steps are after I submit the enrollment forms?

A: Once the forms have been successfully submitted, they will go through a review process and be matched to an existing WIR account. Throughout this process the provider enrollment group will be reaching out to correct forms, ask questions about your forms, and set you up with a WIR account if none exist for you. You will also receive an email with next steps, including a training attestation and readiness checklist survey that need to be filled out and returned to be considered fully enrolled.

Q: Should Vaccines for Children (VFC) providers enroll in the CDC COVID-19 Vaccination Program?

A: Yes, as Emergency Use Authorization of COVID-19 vaccine products expand to include adolescents and children, providers enrolled in the Vaccines for Children (VFC) Program are well situated to enroll in the CDC COVID-19 Vaccination Program to ensure equitable access to COVID-19 vaccination services. VFC providers have direct access to the younger patient population and are familiar with vaccine administration and federal vaccine programs. If you do not receive communication from an enrollment team member within two or three business days of submitting your forms, please email DHSCovidVaccinator@wi.gov.

Though the VFC and COVID-19 Vaccination programs are both federal government programs, they each have distinct requirements based on the associated funding legislation. For this reason, the provider agreements remain separate, and VFC providers must sign and adhere to the requirements of the CDC COVID-19 Vaccination Program Provider Agreement in order to receive and administer COVID-19 vaccines.

Review CDC's website, Vaccines for Children Program vs. CDC COVID-19 Vaccination Program, to assist in understanding the differences in the programs’ requirements.

 Filling out forms

Q: How many Form A's need to be submitted?

A: Only one Form A needs to be submitted for the entire organization. However, a Form A may be submitted for any level of the organization from the clinic all the way up to the corporate level.

Q: Which sites in my organization need to fill out the Form B?

A: Complete one Form B for each site that will be administering COVID-19 vaccine.

  • Two-day vaccine clinics (less than 48 hours) and their second dose clinics one month later do not need a Form B. However, if vaccine is stored over night or held for more than two consecutive days, a Form B is necessary for that location.

  • There may be special conditions in which single- or two-day vaccine clinics need a Form B. These provider registration scenarios determine whether an additional Form B is required for a vaccination clinic.

  • If you are unsure whether you need a Form B, you can preemptively fill out a Form B or email DHSCovidVaccinator@wi.gov for clarification.

Q: Is there a limit to how many Form B’s can be filled out for every Form A?

A: No, there is no limit. If you are going to submit multiple Form B’s for one Form A, please create a different organization location name for each clinic’s Form B so they can be matched to the correct WIR site. All of the forms will still need to have the same reference number and organization's legal name listed at the bottom of their Form A.

Q: What if sites begin submitting Form B’s before the organization’s Form A is submitted?

A: Form B’s will not be registered until the corresponding Form A is verified. Once both sections are submitted and verified, the organization and sites will begin the WIR matching process.

Q: Which providers should be included on my Form B?

A: Any provider licensed in Wisconsin who has prescribing authority or who will have oversight of the handling or administration of COVID-19 vaccine should be included on your Form B’s. This includes titles such as MD, DO, NP, DPM, PA, RPh, and more. Please do not list providers who will be immunizing without prescribing authority, such as EMT, RN, LPN, paramedic, and others.

Q: If additional sites are identified after my original submission, can I submit additional Form B’s at a later date?

A: Yes, please make sure your organization name and reference number on the new Form B’s match your originally submitted forms.

Q: What if I don’t know my IIS identifier?

A: Please include either:

WIR Organization ID Identifier

  • Your Wisconsin Immunization Registry (WIR) Org ID. If you do not know your WIR Org ID, you can use the following steps to find your WIR Org ID, if you have one.

  1. Find a staff member from your organization that has access to WIR as an IR Administrator. Any staff member that is an IR Administrator can find your WIR Org ID by following these steps.

  2. Navigate to manage access and select Edit Organization.

  3. From the list of organizations click the link for the correct location.

  4. The Edit Organization page loads.

  5. You will find a number next to the Org Id. This number is also your IIS Identifier.

  • If you cannot find or do not have your WIR Org ID, you can use your VFC PIN.

  • If you do not have a WIR Org ID nor a VFC PIN, then please submit your forms without them.

 Correcting and submitting forms

Q: I have signed the forms incorrectly and when I submitted it, I got an error. I fixed the signature (per the Signature Instructions), and the enrollment tool still will not accept my forms. What should be done?

A: Unfortunately, you will need to generate a new version of the forms, complete the fields again, sign it correctly, and then resubmit it to the enrollment tool.

Q: What if I need to update information on the forms?

A: Please submit an email request to change information to your forms to DHSCovidVaccinator@wi.gov. You must include the location or organization name listed on your original forms in the subject line. Then include what information you need changed in the body of the email.

Q: When will I know if my forms were submitted correctly?

A: After your forms have been submitted, you should receive a confirmation screen which will indicate that your forms have been submitted correctly. You do not receive an auto-generated email; however, an enrollment team member should contact you within two or three business days. Please email DHSCovidVaccinator@wi.gov to follow up on the status of an application.

Q: How do I add additional health care providers (licensed clinicians) to my Form B that has already been enrolled?

A: Please email DHSCovidVaccinator@wi.gov to request a template for the additional providers’ information. In the subject line please add, “Additional Providers for Form B.”

As a reminder, all licensed health care providers who have prescribing authority or who will have oversight of the handling or administration of COVID-19 vaccine must be listed on the site’s Form B. This includes titles such as MD, DO, NP, DPM, PA, RPh, and more. Please do not list providers who will be immunizing without prescribing authority, such as EMT, RN, LPN, paramedic, and others. Only licensed providers with direct involvement with COVID-19 vaccine should be listed.

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Last Revised: August 12, 2022

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