(Updated 03/01/2021 to highlight the provider registration scenarios that help while filling out required Form B and Redistribution Forms.)
The Wisconsin COVID-19 Vaccine program is enrolling entities that wish to vaccinate. By enrolling in the program, entities and their vaccinators will be approved to administer COVID-19 vaccine in Wisconsin. To become a COVID-19 Vaccinator, all organizations must have an approved Form A and Form B. To redistribute vaccine, all enrolled COVID-19 vaccinators must also have an approved Redistribution Form.
Steps to complete enrollment and redistribution forms
It is important that you complete every step in the enrollment process in order to ensure your submission is processed as quickly as possible. Please use Google Chrome when navigating the enrollment tool. Email(link sends e-mail) us if you have any questions!
Step 1: Log in to the COVID-19 Vaccine Enrollment Tool(link is external) using your Department of Administration (DOA)/Wisconsin Logon Management System username and password.
Step 2: Generate your forms.
USE CAUTION: Once information is entered and site type is chosen, you may NOT go back to change them.
Step 3: Complete and sign your forms. (Updated 03/01/21)
Note: All signatures must be present on a form before submission. Instruction is provided within the forms by hovering over the blue bars in the form.
Step 4: Submit all your forms.
Note: You may submit your organization's forms from any DOA/Wisconsin Logon Management System login. Only submit the completed forms that were specifically generated for your organization with the reference number in step 2 above (this is listed at the bottom right of your generated forms).
Step 5: At various different stages of registration, staff may contact you to ask questions about your submission, correct errors, or provide instructions on next steps. Please respond to this outreach immediately so that we can continue processing your registration. This step may occur after your organization has been approved to receive vaccine.
Step 6: Once your information is verified and your WIR account is configured, the primary contact listed on the Form B will receive an email from DHS with next steps for your organization.
Your vaccine coordinator, back-up coordinator, and other relevant staff must complete the required Wisconsin Immunization Registry (WIR) and vaccine storage and handling trainings. These training videos do not use Adobe Flash Player. You will be emailed a survey to attest that your staff have completed the WIR and the Storage and Handling trainings. Your organization will not be able to order COVID-19 vaccine unless these trainings are completed and acknowledged within 5 days of receipt of the email with the attestation survey.
We also highly recommend your staff takes the CDC's Just in Time trainings for Pfizer-BioNTech(link is external) and Moderna(link is external) vaccines! See the Trainings section below for additional trainings.
563 Carter Court, Suite BKimberly, WI 54136Phone: 920-560-5632 | Fax: email@example.com
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