High Value Care Immunization Referral Toolkit

Each year, thousands of adults in the United States suffer illness, hospitalization, and death from vaccine preventable diseases.  All physicians and their teams play a critical role in promoting immunizations to protect their patients.  Every member of the healthcare team has a role to play in raising immunization rates. This High Value Immunization Referral Toolkit, developed as part of ACP’s I Raise the Rates initiative, provides resources to facilitate more effective and collaborative immunization referrals among those in your patient’s immunization neighborhood.

Pertinent Data Set for Immunization Referrals

Pertinent data sets (PDS) contain critical patient information not typically included in a generic referral request to help ensure an effective and high value clinical engagement by the referred to vaccinating clinician.

Each PDS should address the following high value information for immunization referral:

  • Recommended immunizations
  • Allergy/contraindications
  • Additional information that is essential for effective engagement  
    • Notes on patient background (e.g., patient expresses fear of needles, patient’s dominant arm/preference for administration site, patient’s preferred language, etc.)
    • These checklists are designed to facilitate high value and effective immunization referral engagements.
  • Generic Immunization Referral Request Checklist
  • Generic Immunization Referral Response Checklist

Facilitating Effective Conversations with Patients

Strong and effective vaccine recommendations from trusted clinicians are critical to promoting immunization uptake and building confidence. Many factors contribute to lack of vaccine confidence, including the spread of false or misleading information online, historical mistrust in the medical community, concerns about safety, etc. Facilitating effective conversations with patients will help you understand and address the root of their concerns, build trust, and increase immunization rates.

This set of recommendations is designed to help referring physicians and their teams engage in an effective patient- and family-centered immunization referral process.

Here are some important tips to consider when having vaccine conversations with your patients:


Announce that vaccination is recommended. Save time by making a strong recommendation that clearly communicates the need to get immunized. The majority of your patients will accept a vaccine recommendation from a trusted clinician.

Once the patient has agreed to get vaccinated, provide them with very clear directions. Use the Prepare Your Patient for their Immunization Appointment Checklist.


If the patient expresses any hesitation, inquire to understand the root of their concerns.


Mirror back what you heard back to your patient saying. This step is important to make sure the patient feels heard and that their concerns are validated.

Secure Trust

Secure trust to build confidence. The patient may not agree to get vaccinated during the first conversation. The goal for your conversation should be to focus on building trust and planting a seed.

Download chart

Watch these brief videos on how to make effective vaccine recommendations:

Use these quick resources to practice how to recommend vaccines in a time-saving and effective manner:

Once your patient has agreed to get their recommended vaccines, make sure they are prepared with clear directions and next steps.

Additional Resources that May be Helpful to You and Your Patients:

Identify Immunization Partners

Establishing relationships with immunization partners in your community is key to making high value immunization referrals. Maintain a list of these partners in your practice so that you can make specific recommendations to your patients about where to go to get their immunizations.

Consider the following steps to identify local immunization partners:

  • Review potential immunization partners in your local community by conducting outreach visits, phone calls, or an online search (Vaccine Finder, Health Center search).
  • Ensure that the partners will meet the needs of your patient population by assessing the vaccines offered, hours of vaccine administration (appointment-based or walk-in), insurance coverage requirements, etc.

Establish Immunization Coordination Agreements with Immunization Partners

Once you have identified local immunization partners, it is important to develop a relationship with immunization partners for successful collaboration, including meeting with the immunizing partner to share goals and value sets with the overall goal of improved patient care. As part of these conversations, it is important to establish trust and discuss the needs of both the referring practice and the immunizing partner. An immunization coordination agreement can help facilitate this process.

An immunization coordination agreement defines expectations and responsibilities for the practices involved in a referral relationship. These agreements are implemented to promote increased care coordination and integration. They can address such issues as clinical care arrangements, clinical accountability, preferred clinical content and methods of communication, and expected patient engagement activities.

Use this Sample Care Coordination Agreement for Immunization Referrals to establish effective collaborative relationships with your local immunization partners.