MOBI Six Month Follow-Up Project Type MOBI Trainer Name Site Name Presentation Date Date of follow-up Name of practice staff person providing information Position physician adv practice nurse/pa nurse MA Other Other Position Did the person attend the presentation? Yes No Did the practice have an AFIX measurement shortly before or after the MOBI presentation? No Will consider Interested Not enough kids Yes Does the practice check immunization status every visit? Never Rarely Only when convenient Sometimes Always Does the practice give vaccines even if mild illness is present? Never Rarely Sometimes Frequently Always Does the practice give all vaccines that are due? Never Rarely Sometimes Frequently Always Has the practice updated their vaccine policies/procedures since the MOBI training? Don't have a policy Never Rarely Sometimes Have a policy and regularly update Does the practice regularly use a reminder/recall system? Don't use R/R Rarely Only use when convenient Sometimes Regularly use R/R Does the practice use IMPACT SIIS (Registry) to look up immunizations? Don't use IMPACT SIIS Rarely Only use when convenient Sometimes Regularly use IMPACT SIIS What would the practice say are the biggest obstacles to increasing their immunization coverage rates? (check all that apply) Time commitment Cost Staffing Parental Refusal No same-day immunization-only visits Nurses not authorized to immunize if due Physician's decision I don't know N/A - we have incorporated the strategy(ies) into our practice Other Other obstacles Is there anything else the MOBI office can help you with? If you are human, leave this field blank.
