Uninsured and Underinsured Adult Vaccine

MDH with federal funding is providing vaccine to uinsured and underinsured adults (19 years and older) through 109 clinics throughout the state. These clinics were selected through an application process in January 2011 and will participate in this program through December 2013. This program will be referred to as UUAV (uninsured and underinsured adult vaccine).

Minnesota Uninsured and Underinsured Adult Vaccine Program Annual Provider Agreement 2013 (PDF: 221KB/2 pages)
All health care providers seeking continued enrollment in the UUAV program must complete and sign this form and return to MDH. Due to MDH by January 1, 2013. Revised 10/12

Minnesota Uninsured / Underinsured Adult Vaccine Program Policies and Procedures Manual 2013 (PDF: 643KB/62 pages)
Policies and procedures manual for clinics in the UUAV program.

Vaccine Order Form (PDF: 50KB/2 pages)
Order form for UUAV.

Patient Eligibility Screening Record (PDF: 26KB/1 page)
Screening record for the UUAV clinics.

Billing Office Tips on UUAV (PDF: 26KB/1 page)
Clinics enrolled in the UUAV program can use these tips for billing purposes.

Semi-Annual Report of Doses Administered to Uninsured and Underinsured Adults (PDF: 118KB/1 page)
Report due twice a year for clinics selected to administer UUAV.
Due to MDH by May 31. Revised 4/13
- Online version
Other Forms
Returning nonviable vaccine, vaccine transfer record and the vaccine restitution appeal forms.