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Immunization & Child
Profile Office |
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Immunization & Child
Profile Office |
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To download electronic copies of each material, click on the links below. To order hard copy materials, go to the Department of Printing's online ordering site (click on MyFULFILLMENT) or How to Order Immunization Materials.
Forms (things to fill out) |
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| Certificate of Exemption (June 2011) - effective July 22, 2011 | English (PDF, 69KB) | Espanol (PDF, 392KB) | |
| Sample signature requirements for a temporary medical exemption | English (PDF, 615KB) | ||
| Sample signature requirements for a permanent medical exemption | English (PDF, 612KB) | ||
| Sample signature requirements for a standard religious exemption | English (PDF, 579KB) | ||
| Sample signature requirements for a religious exemption demonstrating membership in a church or religious body | English (PDF, 577KB) | ||
| Sample signature requirements for a personal/philosophical exemption | English (PDF, 576KB) | ||
| Certificate of Immunization Status (Jan. 2010) | English (PDF, 147KB) | Espanol (PDF, 188KB) | Other languages |
| Certificate of Immunization Status Overlay for Kindergarten Entry (November 2011) | English (PDF, 64KB) | ||
| Certificate of Immunization Status Overlay for Child Care/Preschool Entry (November 2011) | English (PDF, 64KB) | ||
| Frequently Asked Questions about the Certificate of Immunization Status and the Certificate of Exemption | English (PDF, 71KB) | ||
| How to Print the CIS from the Immunization Registry | English (PDF, 244KB) | ||
| Child Care Resources | |||
| Child Care Susceptible List (Exempt) | English (PDF, 66KB) | ||
| Child Care Susceptible List (Follow-Up) | English (PDF, 67KB) | ||
| Declination of Influenza Vaccination | English (PDF, 23KB) | ||
| Multiple Signature Logs | - | - | - |
| Influenza | English (PDF, 32KB) | ||
| Pneumococcal Polysaccharide | English (PDF, 27KB) | ||
| Perinatal Hepatitis B Resources | |||
| Confidential Case Report Forms | |||
| Household Contact | English (PDF, 118KB) | ||
| Mother/Infant | English (PDF, 127KB) | ||
| Mother/Infant (Public Health--Seattle & King County) | Call 206-296-4774 or 206-205-8627 (Ruby Lopez) to order this form | ||
| Sample Letters | |||
| Before Baby is Born | English (Word, 33KB) | Other languages | |
| After Baby is Born | English (Word, 33KB) | Other languages | |
| Serology (Blood) Testing Completed | English (Word, 28KB) | Other languages | |
| School Resources | |||
| Glossary of Immunization and Public Health Terms | English (PDF, 160KB) | ||
| How to Print the CIS from the Immunization Registry | English (PDF, 244KB) | ||
| Individual Vaccine Requirements | English (PDF, 335KB) | ||
| School Susceptible List (Exempt) | English (PDF, 64KB) | ||
| School Susceptible List (Follow-Up) | English (PDF, 66KB) | ||
| Vaccine Administration Record | English (PDF, 37KB) | ||
| Sample Letters | - | - | - |
| Graduating Senior Letter | English (Word, 48KB) | ||
| HPV Letter for Private Schools | English (Word, 44KB) | ||
| HPV Letter for Public Schools | English (Word, 52KB) | ||
| HPV and Meningococcal Letter (combination) | English (Word, 63KB) | ||
| Meningococcal Letter | English (Word, 51KB) | ||
| Notice of Child's Conditional Immunization Status (Public and Private Schools) | English (Word, 61KB) | ||
| Notice of Exclusion for Immunization Noncompliance (Private Schools) | English (Word, 59KB) | ||
| Notice of Exclusion for Immunization Noncompliance (Public Schools) | English (Word, 62KB) | ||
| Tdap Letter for 6th Grade | English (Word, 53KB) | ||
| Tdap Letter for 7th Grade | English (Word, 48KB) | ||
| Tdap/Varicella Letter (combination) | English (Word, 35KB) | ||
| Screening Questionnaires | - | - | - |
| For Adult Immunization | English (PDF, 131KB) | ||
| For Child and Teen Immunization | English (PDF, 73KB) | ||
| For Injectable (Inactivated) Influenza Vaccination | English (PDF, 71KB) | ||
| For Intranasal Influenza Vaccination | English (PDF, 82KB) | ||
| Standing Orders for Administering Influenza Vaccine | - | - | - |
| To Adults | English (PDF, 60KB) | ||
| To Children | English (PDF, 63KB) | ||
| Temperature Monitoring Log | English (PDF, 199KB) | ||
| Vaccine Administration Record | English (PDF, 37KB) | ||
| Varicella Vaccine | - | - | - |
| Provider Certification | English (PDF, 169KB) | ||
Brochures, Flyers and Posters (things you can print and order) |
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| Adolescent and Adult Materials | - | - | - |
| Adolescent and Adult Immunization Community Action Plan for Seasonal and Pandemic Influenza, Phase I Executive Summary and Gap Matrix | English (PDF, 93KB) | ||
| Adolescent Immunization Fact Sheet | English | Espanol | |
| Adolescent Reminder/Recall Postcard - Contact the Child Profile Help Desk at 1-800-325-5599 for assistance with the Washington Immunization Information System Reminder/Recall feature. | English | ||
| Adult Immunizations--Protect Yourself for Life brochure | English | ||
| Adult Immunizations: Your Best Shot at Good Health poster (16 x 22) | English | ||
| Are You 60 or Older? You May be Due for Immunizations brochure | English | ||
| Immunizations are Important at Every Age brochure | English | ||
| Results of the Washington State Department of Health Adolescent Immunization Focus Groups |
English (PDF, 419KB) |
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| Will You Be Pregnant This Flu Season? poster (11 x 17) | English | Espanol | |
| Check Your Vials poster | English | ||
| Child Profile Health Promotion Materials | English | Espanol | |
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English and Espanol combined (PDF, 307KB) | ||
Child Profile poster |
English and Espanol combined (PDF, 432KB) | ||
| Childhood Materials | - | - | - |
| Child Profile Childhood Health Record, Birth-18 Years booklet | English | Espanol (PDF, 268KB) | |
| Immunizations: A Guide to Protecting Your Child brochure | English | Espanol (PDF, 561KB) | Other languages |
| Lifetime Immunization Record Card | English | ||
| Plain Talk About Childhood Immunizations, 6th Edition | English | Espanol | |
| Watch and Help Me Grow, Birth to 18 Months brochure | English (PDF, 1.7MB) | Espanol (PDF, 621KB) | |
| Watch and Help Me Grow, 18 Months to 3 Years brochure | English (PDF, 1.7MB) | Espanol (PDF, 672KB) | |
| Watch and Help Me Grow, 3 to 5 Years brochure | English (PDF, 829KB) | Espanol (PDF, 958KB) | |
| Childhood Immunization Coverage for Washington State 1995-2002 | English (PDF, 2MB) | ||
| Childhood Immunization Coverage for Washington State 2003-2005 | English (PDF, 166KB) | ||
| Cover Your Cough | English | Espanol | Other Languages |
| "Do Not Unplug" sticker (3 x 3) | English | ||
| DTaP Materials | |||
| DTaP Parent Fact Sheet - Help Your Baby Fight Pertussis! | English | Espanol (PDF, 404KB) | |
| DTaP Provider Fact Sheet | English | ||
| Tips to Increase 4th DTaP Rates | English | ||
| Flu Materials | - | - | - |
| Centers for Disease Control and Prevention Flu Resources | English | Espanol | |
| Protect Your Family from the Flu | English | Espanol (PDF, 938KB) | |
| WashYourHandsingTon flu outreach campaign resources | |||
| Will You Be Pregnant This Flu Season? poster (11 x 17) | English | Espanol | |
| Hepatitis Materials | - | - | - |
| Hepatitis A & B Vaccines - Recommended Dosages and Schedules | English (PDF, 110KB) | ||
| Hepatitis B Facts: Testing and Vaccination | English (PDF, 99KB) | ||
| Hepatitis B information for adults and children from endemic areas flyer | English (PDF, 76KB) | Other languages | |
| Hepatitis B Prevention: Asians and Pacific Islanders Information posters | Other languages | ||
| Hospital Sticker (triangle shape): "ALERT: Give HBIG and Hep B Vaccine" April 2010 |
English
(Word, 608KB) |
Other languages | |
| Perinatal Hepatitis B brochure | Other languages | ||
| Prenatal Sticker (2x3 sticker): "Reporting HBsAg-positive Mothers Required" April 2010 |
English
(Word, 73KB) |
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| Pediatric Sticker (2x3 sticker): "This baby needs hepatitis B immunization" April 2010 |
English
(Word, 74KB) |
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| Start Protecting Your Baby at Birth with Hepatitis B Vaccine brochure | English | Other languages | |
| What Asians and Pacific Islanders Need to Know About Hepatitis B | English (PDF, 6MB) | Other languages | |
| Immunization Guidelines for the Use of State-Supplied Vaccines
July 1, 2011 |
English (PDF, 88KB) | ||
| Reminder/Recall Card | English | Espanol | |
| Meningitis Materials | - | - | - |
| Meningitis on Campus brochure | English (PDF, 935KB) | ||
| Off to College? brochure | English | ||
| Pneumococcal Polysaccharide Vaccination Pocket Guide | English (PDF, 67KB) | ||
| Recommended Immunization Schedules (including catch-up schedules) | - | - | - |
| 2011 Adolescent (Ages 7-18) | English and Espanol | ||
| 2011 Adult | English | ||
| 2011 Childhood (Ages 0-6) | English and Espanol | ||
| Tdap Materials | |||
| Tdap Adult poster (8.5 x 11) | English | ||
| Tdap Child Care Provider flyer | English (PDF, 165KB) | Espanol (PDF, 65KB) | |
| Tdap Grandparents flyer | English (PDF, 90KB) | ||
| Tdap Health Care Provider flyer | English (PDF, 98KB) | ||
| Tdap Parents flyer | English | Espanol (PDF, 2MB) | |
| Think They're Too Old for Immunizations? Think Again, Tdap card for parents (4 x 9) | English | ||
| Think They're Too Old for Immunizations? Think Again, Tdap poster for parents | English | ||
| Vaccine Handling and Storage Chart | English | ||
| Vaccine Information Statements (VIS) in Video and Audio Format | English | Other languages | |
| Vaccine Information Statements | - | - | - |
| DTaP (Diphtheria/Tetanus/Pertussis) | English | Espanol | Other languages |
| Hepatitis A | English | Espanol | Other languages |
| Hepatitis B | English | Espanol | Other languages |
| Hib | English | Espanol | Other languages |
| HPV (Gardasil and Cervarix) | English | Espanol | Other languages |
| Influenza (Live, Intranasal and Inactivated) | English | Espanol | |
| MMR (Measles/Mumps/ Rubella) | English | Espanol | Other languages |
| MMRV (Measles/Mumps/Rubella/Varicella) | English | Espanol | |
| Meningococcal | English | Espanol | Other languages |
| Multiple Vaccines | English | Espanol | Other languages |
| Pneumococcal Conjugate (PCV13) | English | Espanol | |
| Pneumococcal Polysaccharide (PPSV23) | English | Espanol | Other languages |
| Polio | English | Espanol | Other languages |
| Rotavirus | English | Espanol | Other languages |
| Shingles (Herpes Zoster) | English | Espanol | Other languages |
| Td/Tdap | English | Espanol | Other languages |
| Varicella (Chickenpox) | English | Espanol | Other languages |
| Vaccine Requirement Charts | - | - | - |
| Child Care/Preschool Attendance 2012-2013 | English (PDF, 553KB) | ||
| Child Care/Preschool Attendance 2011-2012 | English (PDF, 170KB) | Espanol (PDF, 175KB) | |
| K-12 School Attendance 2012-2013 | English (PDF, 551KB) | ||
| Parents - Are
your Kids Ready for School? Required Immunizations for School Year 2012-2013
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English (PDF, 541KB) | ||
| K-12 School Attendance 2011-2012 | English (PDF, 158KB) | Espanol (PDF, 179KB) | |
| "Warning: Do Not Unplug" sticker (3.5 x 8) | English | ||
| Whooping Cough Materials | - | - | - |
| Tdap Adult poster (8.5 x 11) | English (PDF, 75KB) | ||
| Tdap Child Care Provider flyer | English (PDF, 165KB) | Espanol (PDF, 65KB) | |
| Tdap Grandparents flyer | English (PDF, 90KB) | ||
| Tdap Health Care Provider flyer | English (PDF, 98KB) | ||
| Tdap Parents flyer | English (PDF, 81KB) | Espanol (PDF, 2MB) | |
Last Update: 02/03/2012 11:22 AM