Best Practices for Documenting Vaccine Refusals

Version 14.10

When documenting vaccine refusals in OP 14, it is important to understand what you intend to accomplish with the refusal documentation and how OP 14 behaves with the information you enter.

To make your practice team aware of refused vaccines, your practice should agree on how and where to make this notation so that all members of the team will look in the same place for this information. Many practices find that adding vaccine refusals to the Problem List makes it visible for all to see without opening specific notes or encounters. By putting the vaccine refusal in sort position 1, it will always be on top. In addition, the vaccine refusal will show up on the patient Problem List on the OP Patient Portal and indicate to the family how important you believe their refusal is.

If it is a refused vaccine for a highly contagious infection (like MMRV), some practices create a popup alert (see the screenshot below) so that it triggers anyone scheduling an appointment to ask appropriate questions and potentially ask that they not come into the waiting room and put others at risk.

Many practices will also put the information on the bottom right of the chart in the Health Summary section so that it is available and will be included in printed School/Camp forms:

For medical-legal and auditing purposes, it is always a good idea to document vaccine refusals in the body of the Well Visit/Encounter note:

It’s always a good idea to use the refusal ICD10 codes and make sure they are one of the four diagnoses that go with the claim to the payer. This provides payers with documentation that you offered a vaccine and the parent (or patient, which is ICD10 Z28.21) refused:

If you use the Refusal radio button when ordering vaccines and select the Create Consent Task for Refusals checkbox, the only outcome is to create a task for your appropriate staff to get the Vaccine Refusal form signed:

The Order Section of the note summary will then include the completed task:

Note:  The above radio buttons do not change the Vaccine Logic to Continue to Forecast the missing vaccine and do not add the entry into vaccine logic.

Note: None of the above behaviors will remove these patients from recalls. When running a recall for due/overdue vaccines in Demographic Analysis and Recall, these patients will be included in the report. If your office contacts them regarding the due/overdue vaccines, they may be upset if they have signed a refusal. However, some practices may feel that this just reinforces how important the practice believes up-to-date immunizations to be..

If you use the indicators under VacLogic to record a refusal, it will show up on the immunization forecast as refused:

However, no matter how many times they refuse, it will only show up once on the Forecast (most recent). You would have to visit the Status Indicators by Antigens tab or Overview tab to see this.

Overview tab where multiple refusals with dates will be visible:

Inside the Chart, the OP system will no longer forecast this vaccine as due:

Running recalls with Demographic Analysis and Recall, these patients will never show up, and you will have no easy way to find them during an outbreak to recall them.

Bottom Line: If you enter a refusal on the Vaccine Indicators, the OP system will no longer forecast this vaccine as due.