physician interested in getting your elderly patients vaccinated for shingles
In a moment after your NPI number is validated you will be allowed to download the paperwork required for immunizing pharmacists listed in the collaborative drug therapy management (CDTM) agreement to administer Zostavax® to your patients pursuant to 247 CMR 16.03 Section 5(b).
Merck has now gained FDA approval for Zostavax to be administered to patients aged 50 and older. The protocol section of our CDTM agreement has been updated to include those patients now eligible to receive the vaccine per manufacturer recommendations.
What we need from you (Please note the referral/authorization forms you will see after validating your NDI MUST be signed by a physician):
1. Filled out and signed referral/authorization form for each patient you want vaccinated.
2. New prescription for Zostavax® for each patient you want vaccinated
These two items can be faxed over to us or sent with the patient. Once we receive these forms we will bill the patient’s insurance and notify them of the total cost prior to administration. If they agree we will review a brief screening questionnaire with them and have them sign the consent form.
What you will receive from us:
1. A copy of the patient’s signed consent form with the pertinent vaccine
information for you to include in their record