Pneumococcal vaccinations are recommended for adults living with HIV; however, eligibility criteria are complex. At a clinic specializing in the care of lesbian, gay, bisexual, transgender, or queer/questioning persons, only 36% of patients who were vaccine-eligible received the vaccination. A set of decision trees was developed to guide clinic personnel in determining whether a vaccine is recommended. The provider then determined whether the vaccine was appropriate based on each patient's complete clinical presentation. When appropriate, patients were offered the vaccine at the same appointment. This practice change led to a 22% increased vaccination rate.