Apply for the Hep B Birth Dose Honor Roll

About the Honor Roll

Launched in 2013, Immunize.org’s Hepatitis B Birth Dose Honor Roll recognizes U.S. birthing facilities that have attained a hepatitis B vaccine birth dose coverage rate of 90% or greater. Honorees must also have written birth dose policies in place, including procedures and protocols in the event of medical errors.

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Criteria for Inclusion

To be included in Immunize.org’s Hepatitis B Birth Dose Honor Roll:

You have achieved, over a 12-month period, a coverage rate of 90% or greater for administering hepatitis B vaccine before facility discharge to all newborns (regardless of weight). This includes newborns whose parents refuse vaccination.
You have written and implemented birth dose policies, procedures, and protocols to protect all newborns from hepatitis B virus infection prior to facility discharge

How to Apply

Fill out the form below and tell us about you and your facility. We also have a printable form if you wish to fax, mail, or email your application.

Further Resources

Letter of Endorsement

Support for Universal Hepatitis B Birth Dose.

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Printable Application

Apply by fax, mail, or email, using this form.

View PDF

Application

Fill out the form and tell us about your facility and vaccination policy. All fields are required unless otherwise specified.

Your Contact Information

First name *

Last name *

Job title *

Department *

Phone *

Email *

Facility Information

Name of facility *

Other facility type *

Address 1 *

Address 2 (optional)

City *

Zip code *

Which most closely describes the type of community your facility resides in?

Approximately how many births occur per year in your healthcare facility?

Social Media Information (optional)

If accepted for the Honor Roll, Immunize.org will announce this recognition on our social media channels. Please provide any social media handles for the facility that we may use in our posts.

Facebook

Instagram

Twitter

Qualifications for Enrollment

To be included in Immunize.org’s Hepatitis B Birth Dose Honor Roll, a birthing facility must have:

1. Achieved, over a 12-month period, a coverage rate of 90% or greater for administering hepatitis B vaccine before facility discharge to all newborns (regardless of weight), including those whose parents refuse vaccination. (Newborns who are transferred to a different facility after birth due to medical problems do not need to be included in the denominator.)

Qualified for enrollment *Please check this box if your birthing facility meets this qualification

What coverage rate did you achieve for administering hepatitis B vaccine to all newborns prior to facility discharge?

What is the starting and ending date of the 12-month time period over which this rate was measured?

Starting date: *

Ending date: *

Please describe how the birth dose coverage level was measured:

Coverage measurement details (Optional)0 / 500

Do you have an additional period you wish to apply for?Do you have an additional period you wish to apply for? You may apply for an additional 12-month period as long as it does not overlap with the first 12-month period listed

What coverage rate did you achieve for administering hepatitis B vaccine to all newborns prior to facility discharge?

What is the starting and ending date of the 12-month time period over which this rate was measured?

Additional period - Starting date: *

Additional period - Ending date: *

Please describe how the birth dose coverage level was measured:

Additional period - Coverage measurement details (Optional)0 / 500

2. Implemented written policies, procedures, and protocols to administer the universal hepatitis B vaccine birth dose to all newborns prior to facility discharge.

Policies are formally documented *Yes, our birth dose policies are formally documented

3. Generally, acceptance into the honor roll requires adoption of all the following policy components, but exceptions to that requirement may be granted.

Select “Yes” if your birth dose policies include the following items:

a. Parents are informed about the importance of the hepatitis B vaccine birth dose and that it is recommended for all newborns. *YesNo

b. All newborns routinely receive hepatitis B vaccine within 24 hours of birth. *YesNo

c. A review is performed as to whether the correct screening test, hepatitis B surface antigen (HBsAg), was ordered for the mother during this pregnancy. *YesNo

d. The result of the mother’s HBsAg screening test is reviewed. *YesNoNote: It is best, if at all possible, that the policy calls for review of a copy of the original HBsAg test result, and not a transcribed or hand-entered report.

e. An HBsAg blood test is ordered ASAP if an incorrect test was ordered on the mother or if no test result is included on her chart. *YesNo

f. Infants born to HBsAg-positive mothers receive hepatitis B vaccine and hepatitis B immune globulin (HBIG) within 12 hours of birth. *YesNo

g. Infants born to mothers whose HBsAg status is unknown receive hepatitis B vaccine within 12 hours of birth. *YesNo

h. Infants who weigh less than 2,000 grams and are born to mothers whose HBsAg status is unknown receive HBIG (in addition to hepatitis B vaccine) within 12 hours of birth. *YesNo

i. Routine newborn admission orders include a standing order to administer hepatitis B vaccine to all infants (similar to standing orders to administer Vitamin K and ophthalmic antibiotic). *YesNo

i. Notification of the state or local health department’s perinatal hepatitis B prevention program is done prior to discharge (or as soon as known, if after discharge) for all mothers whose HBsAg test result is positive. *YesNo

Vaccine Topics

General Topics

Patient Safety Honor Rolls

Apply for the Hep B Birth Dose Honor Roll

About the Honor Roll

Criteria for Inclusion

How to Apply

Further Resources

Application

Your Contact Information

Facility Information

Which most closely describes the type of community your facility resides in?

Approximately how many births occur per year in your healthcare facility?

Social Media Information (optional)

If accepted for the Honor Roll, Immunize.org will announce this recognition on our social media channels. Please provide any social media handles for the facility that we may use in our posts.

Qualifications for Enrollment

To be included in Immunize.org’s Hepatitis B Birth Dose Honor Roll, a birthing facility must have:

What coverage rate did you achieve for administering hepatitis B vaccine to all newborns prior to facility discharge?

What is the starting and ending date of the 12-month time period over which this rate was measured?

Please describe how the birth dose coverage level was measured:

What coverage rate did you achieve for administering hepatitis B vaccine to all newborns prior to facility discharge?

What is the starting and ending date of the 12-month time period over which this rate was measured?

Please describe how the birth dose coverage level was measured:

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