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Vaccine Information Statements

Vaccine Information Statements

Vaccine Information Statements (VIS)

A Vaccine Information Statement (VIS) is a one-page, two-sided, information sheet, produced by the Centers for Disease Control and Prevention (CDC). VIS inform vaccine recipients - or their parents or legal representatives - about the benefits and risks of a vaccine. Federal law requires that VIS be given out whenever certain vaccinations are given. The VIS must be given out at the time of each vaccination - prior to administration of the vaccine.

Vaccine Information Statements (VIS) are available to view and access on the CDC website. The Michigan Department of Health and Human Services (MDHHS) will be transitioning away from printed versions in the warehouse. During this transition, providers can order small amounts of VIS through local health departments. For local health department contact information, visit michigan.gov/lhdmap

 

 

VIS Links

VIS Webinar

Ways to give a VIS

  • Paper copies of the VIS can be printed and given to patients prior to vaccination.
  • Permanent, laminated office copies may be given to patients to read prior to vaccination.
  • Patients may view VISs on a computer monitor or other video display.
  • Patients may read the VIS on their phone or other digital device by downloading the pdf file from CDC's website.
  • Patients may be given a copy of a VIS during a prior visit, or told how to access it through the internet, so they can read it in advance. These patients must still be offered a copy to read during the immunization visit, as a reminder.

Patients must still be offered a copy of the VIS to take away following the vaccination. The patient may decline.

Please note, the MCIR Immunization Notice Form and the MCIR Immunization Notice Form (Spanish) is also available to be given to patients in the ways listed above.


FAQ: VIS and MCIR Immunization Notice Form Process

  • The implementation process should begin immediately. The Michigan-specific VIS forms should be discarded and the CDC VISs along with the MCIR Immunization Notice Form should be used in your office moving forward. The updated Michigan VIS page and the MCIR Immunization Notice form can be found at www.michigan.gov/vis.

  • Yes, the Michigan-specific VIS with the Michigan statement on it should be removed. The CDC VIS(s) should be used and are available at www.michigan.gov/vis. The new MCIR Immunization Notice Form will be found on the same webpage. 

  • No, we ask that you move to the VIS forms posted at www.michigan.gov/vis immediately. Please work to discard previous forms with the Michigan statement on it and establish a process for the office.

  • Yes, work is being done to make this available on the website. When it is completed, a message will be sent out. 
  • The new MCIR Immunization Notice Form may be implemented in the office by sharing a paper copy, laminating the form for review, viewing it on the webpage, or using a QR code to link to the document for review. Per Michigan Compiled Law (MCL) section 333.9206 (2), MDHHS must provide the form, and the form cannot be modified. But the manner in which the form is implemented is up to the provider’s office. No matter how the form is provided, it is recommended to document that the form was provided to the parent, guardian or person in loco parentis, based on the current office policy.
  • The signature on the MCIR Immunization Notice form is an acknowledgment that the form has been received. Per Michigan Compiled Law (MCL) section 333.9206 (2), the form must be provided to all parents, guardians, and person in loco parentis who are having a child immunized, but it does not expressly require that a signature is collected. A collection of a signature would likely be the simplest way for an office to demonstrate compliance, but MDHHS recognizes that this is not the only way to demonstrate compliance. How this process is implemented, which includes whether the office requires a signature for documentation purposes, is per the policy developed by that office.  It is recommended that office management and the legal advisors be involved in the development of the process.
  • Per MCL 333.9206 (2), the form must be provided to all parents, guardians, and person in loco parentis who are having their child immunized. For adult patients who are receiving a vaccine it is considered best practice to use the MCIR Immunization Notice form.
  • It is based on the office policy set by the provider. MCL 333.9206 (2) does not provide additional requirements for how the form is to be documented. The office would follow their standard documentation policies.

  • When providing immunizations for the minor without a parent/guardian present, the office policy that is established for educating and providing a VIS, should be followed. This would include implementing the policy for the MCIR Immunization Notice Form.  When setting office policy, it is recommended to have the office legal advisor review the process.  MCL 333.9206 (2) requires that the form is provided to a parent/guardian/person in loco parentis before the vaccine is administered.

  • Documenting a Refusal to Consent to Vaccination forms
  • This is not a yearly acknowledgement and must be presented to the parent, guardian or person in loco parentis at each immunization encounter before the vaccines are received.
  • Yes, the MCIR Immunization Notice form should be provided to the parent, guardian or person in loco parentis at every vaccine encounter, even if they are receiving the same vaccine. This form acknowledges that the vaccines received will be entered into MCIR.
  • No. Per the public health code the MCIR Immunization Notice Form, based on MCL 333.9206 (2), must be provided to all parents, guardians and person in loco parentis who are having their child immunized. The law states the form must be provided on “the form provided by the department.”
  • Yes. It is based on the office policy for how to share the form. You will need to contact your EMR vendor if you wish to have the form added to your EMR.
  • The office policy should determine the acknowledgement/signature requirements. If the office chooses to provide this form via a QR code or website, then the office policy should reflect how it will be noted that the form was provided.
  • The office policy would determine if scanning the MCIR Immunization Notice form into the patient chart should be done.
  • No. The MCIR Immunization Notice Form must be provided to the parent/guardian/person in loco parentis when vaccines are being administered. Entering a historical immunization record is not a vaccine encounter.
  • MDHHS does not require retention of the completed forms for any period of time. Look to your office retention schedule instead, for specific guidelines.
  • No, the form must be provided to the parent, guardian or person in loco parentis to acknowledge the information is going into MCIR. The parent, guardian or person in loco parentis should acknowledge that they understand the information is going into MCIR and at that time, after reviewing the education in the MCIR Immunization Notice form, they may state they object to that process, and providers should direct them to the MCIR Opt Out Form. If an objection is not stated, the information must be entered into MCIR. The signature is simply an acknowledgment that the health care provider complied with the statutory duty to provide the MCIR Immunization Notice Form as required by law.

  • When requested by the patient/parent/guardian or person in loco parentis, the provider should direct the patient/parent/guardian or person in loco parentis to the MCIR Opt Out Form prescribed by MDHHS. This form can be found on the MCIR.org website.  

    • If option 1 is selected by the patient/parent/guardian or person in loco parentis, the provider must not report the specified immunization(s) to MCIR.  
    • If option 2 is selected by the patient/parent/guardian or person in loco parentis, the provider must send the completed form to the MCIR helpdesk for appropriate processing.  
    • If option 3 is selected by the patient/parent/guardian or person in loco parentis, the provider should send the completed form to the MCIR helpdesk for appropriate processing or direct the patient/parent/guardian or person in loco parentis to the MCIR.org website to complete the opt out process.  

    Please NOTE: The MCIR Immunization Notice Form is an acknowledgement that immunization information will be entered into MCIR on the patient/parent/guardian or person in loco parentis behalf and should be provided at each immunization encounter.  The MCIR Immunization Notice Form is NOT the MCIR Opt Out Form. The MCIR Opt Out Form can be found on the MCIR.org website.  

  • Yes, the updated form will be posted at www.mcir.org. The MCIR opt-out form will include 3 options, which are only used when the person wants to opt-out of having their immunization information shared in MCIR. If they choose to opt-out, they should work with their provider and the MCIR team to ensure the appropriate paperwork is completed. General Contact – mcir.org.

Frequently Used Resources

CDC Information