Charting: Refuse a Vaccine

Version 21.3

About

The steps below instruct on how to document a vaccine refusal when charting. 

WarningSelecting a vaccine refusal will discontinue the vaccine's forecast. If you want the vaccine to continue to forecast, select Defer.

  1. Access the patient's chart from the Clinical, Practice Management, or Billing tab.
  2. Create or open a Well Visit and click Plan/Orders or an Encounter Note and click Orders.
  3. Click the Imm tab.
  4. Select the radio button in the Ref column for the vaccine which is being refused.
  5. Click the Create button. The Refuse/Defer Vaccine window displays.

NoteYou may also click the Do Now button and the Refuse/Defer Vaccine window will display.

  1. Complete the below fields.
  • Reason: Select a radio button to indicate the reason for refusing the vaccine.
  • Details: Click the drop-down arrow and select from the list.
  • Contraindication: This field is not applicable when refusing a vaccine.
  • Vaccine: Populates with the vaccine chosen in the Plan/Orders window.
  • Comments: Type additional comments, if necessary.
  • Create consent task for refusal/deferral: Click the checkbox to create a task for a refusal consent form if this is your Practice's policy.
  1. Click Save.
  2. Click OK in the confirmation window to create the immunization task.

Tip: A task will be created to complete the Vaccine Refusal Consent Form if the checkbox was selected in the Refuse/Defer Vaccine window.

Re-forecast a Refused Vaccine

Once a vaccine is marked as refused, the vaccine will not forecast. If you wish to begin forecasting the vaccine, you must delete the refusal following the below steps. The deletion of the vaccine refusal will be recorded in the Audit Trail.

  1. Access the patient's chart from the Clinical, Practice Management, or Billing tab.
  2. Click Immunizations.
  3. Click the Complete List tab.
  4. Highlight the vaccine that was refused, and click the Delete button.

How Are Refused Vaccines Sent to the Registry?

As far as OP is aware, all state immunization registries (IIS) accept documentation of refusals.

At this time, vaccine refusals go to the registry ONLY IF and WHEN a vaccine is given subsequently. That is, if you document a child's flu vaccine refusal on 11/1/22, that vaccine refusal will only be sent to your state immunization registry when you document the child's next vaccination, which might be several months or even years later. This is because only documentation of actual vaccinations -- either administered or historical -- trigger refusals to be sent. Fortunately, states do not have timelines for submission of refusals to their IIS like they do for vaccines, which must be submitted within 24 hours-2 weeks (depending on the state). 

However, this means that the following refusals are NOT automatically sent:

  • A child who has never had vaccines, whose parents refuse vaccines and that refusal is documented in OP. Because the refusal is not later followed by adding a historical or administered vaccine, there is nothing to trigger the sending of the prior refusal.
  • A child who did have vaccines, but whose parents now refuse any further vaccines. Since the administered vaccines were all entered prior to the refusal, and ALL vaccines are refused after the refusal, the refusal is never sent.

To trigger these types of refusals to send, the end user can use this process:

  1. Enter a "fake" vaccine as a historical vaccine for that child, e.g. through Quick Entry, with today's date. For appropriate audit trail purposes, we recommend using a vaccine that the child couldn't possibly have received (e.g. adenovirus vaccine, anthrax vaccine, etc).
  2. Wait 5-7 minutes for the "fake" vaccine to be sent to the registry (along with refusals).
  3. Then, delete the "fake" vaccine so that OP and the registry will be correct.

Addition of the fake entry triggers all previous refusals to get sent; deletion of the fake entry causes the child's OP record and the immunization record to be correct.

Similarly, if entering historical vaccines in a child who has refused vaccines, enter the refusals first, THEN the historical vaccines, so the refusals will be submitted to the registry.

Version 20.17

About

The steps below instruct on how to document a vaccine refusal when charting. 

WarningSelecting a vaccine refusal will discontinue the vaccine's forecast. If you want the vaccine to continue to forecast, select Defer.

  1. Access the patient's chart from the Clinical, Practice Management, or Billing tab.
  2. Create or open a Well Visit and click Plan/Orders or an Encounter Note and click Orders.
  3. Click the Imm tab.
  4. Select the radio button in the Ref column for the vaccine which is being refused.
  5. Click the Create button. The Refuse/Defer Vaccine window displays.

NoteYou may also click the Do Now button and the Refuse/Defer Vaccine window will display.

  1. Complete the below fields.
  • Reason: Select a radio button to indicate the reason for refusing the vaccine.
  • Details: Click the drop-down arrow and select from the list.
  • Contraindication: This field is not applicable when refusing a vaccine.
  • Vaccine: Populates with the vaccine chosen in the Plan/Orders window.
  • Comments: Type additional comments, if necessary.
  • Create consent task for refusal/deferral: Click the checkbox to create a task for a refusal consent form if this is your Practice's policy.
  1. Click Save.
  2. Click OK in the confirmation window to create the immunization task.

Tip: A task will be created to complete the Vaccine Refusal Consent Form if the checkbox was selected in the Refuse/Defer Vaccine window.

Re-forecast a Refused Vaccine

Once a vaccine is marked as refused, the vaccine will not forecast. If you wish to begin forecasting the vaccine, you must delete the refusal following the below steps. The deletion of the vaccine refusal will be recorded in the Audit Trail.

  1. Access the patient's chart from the Clinical, Practice Management, or Billing tab.
  2. Click Immunizations.
  3. Click the Complete List tab.
  4. Highlight the vaccine that was refused, and click the Delete button.