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Immunization Program

CHILD Profile

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Forms and Publications

To download electronic copies of each material, click on the links below. To order hard copy materials, go to Order Materials from the Department of Printing or How to Order Immunization Materials.


Forms (things to fill out)

 
Certificate of Exemption English (PDF, 47 KB) Espanol (PDF, 116 KB) Other languages
Certificate of Immunization Status      
Revised Oct. 2008 English (PDF, 100 KB) Espanol (PDF, 178 KB) Other languages
Certificate of Immunization Status Overlay for Kindergarten Entry (Oct. 2008) English (PDF, 28 KB)    
Certificate of Immunization Status Overlay for Kindergarten Entry (Jan. 2006) English (PDF, 52 KB)    
Certificate of Immunization Status Overlay for Child Care/Preschool Entry (Oct. 2008) English (PDF, 28 KB)    
Frequently Asked Questions about the Certificate of Immunization and Certificate of Exemption Form English ( PDF, 59 KB)    
Instructions for Printing the Certificate of Immunization Status from the CHILD Profile Immunization Registry English (PDF, 194 KB)    
Confidential Case Report Forms - - -
Household contact English (PDF, 118 KB)    
Mother/Infant English (PDF, 127 KB)    
Declination of Influenza Vaccination English (PDF, 23 KB)    
Influenza Vaccine - - -
Influenza Vaccine Screening Form and Quick Reference Guide English (PDF, 79 KB)    
Planning Formula Worksheet English (PDF, 63 KB)    
Planning Formula Worksheet Example English (PDF, 51 KB)    
Multiple Signature Logs - - -
Generic - Please use the Vaccine Administration Record - - -
Influenza English (PDF, 32 KB)    
Pneumococcal Polysaccharide English (PDF, 27 KB)    
Sample Letters to Parents - - -
Combination HPV and Meningococcal letter English (Word, 44 KB)    
Graduating Seniors Immunization Record English (Word, 28 KB)    
Hepatitis B Immunization Change Notice English (PDF, 48 KB)    
HPV Letter for Private Schools English (Word, 27 KB)    
HPV Letter for Public Schools English (Word, 34 KB) Under revision Under revision
Meningococcal English (Word, 37 KB)    
Notice of Incomplete Immunizations English (Word, 71 KB) Espanol (Word, 74 KB)  
Tdap - 6th grade English (Word, 36 KB)    
Tdap - 7th grade English (Word, 33 KB)    
Tdap/Varicella English (Word, 35 KB)    
Varicella Child Care Letter English (Word, 36 KB) Espanol (Word, 756 KB)  
Varicella School Letter English (Word, 38 KB) Espanol (Word, 638 KB)  
Varicella/MMR Minimum Interval Infraction English (Word, 28 KB)    
Screening Questionnaires - - -
For Adult Immunization English (PDF, 131 KB)    
For Child and Teen Immunization English (PDF, 73 KB)    
For Influenza Vaccine 2007 English (PDF, 153 KB) Espanol (PDF, 161 KB)  
For Injectable (Inactivated) Influenza Vaccination English    
For Intranasal Influenza Vaccination English    
Staff Immunization History Form English (Word, 61 KB)    
Standing Orders for Administering Influenza Vaccine - - -
To Adults English    
To Children English    
Temperature Monitoring Log English (PDF, 199 KB)    
Vaccine Administration Record English (PDF, 37 KB)    
Varicella Vaccine - - -
Provider Certification English (PDF, 22 KB)    

Brochures, Flyers and Posters (things you can print and order)

 
2008 National Infant Immunization Week posters English Espanol  
Adolescent and Adult Materials - - -
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 CHILD Profile Immunization Registry Reminder/Recall feature. English

PDF, 126 KB
Word, 2 MB
Publisher, 2 MB

   
Adult Immunizations--Protect Yourself for Life brochure English (PDF, 2 MB)    
Adult Immunizations: Your Best Shot at Good Health poster (16 x 22) English (PDF, 3 MB)    
Are You 60 or Older? You May be Due for Immunizations brochure English (PDF, 2 MB)    
Immunizations are Important at Every Age brochure English (PDF, 435 KB)    
Results of the Washington State Department of Health Adolescent Immunization Focus Groups

English (PDF, 419 KB)

 

 

Will You Be Pregnant This Flu Season? poster (11 x 17) English (PDF, 877 KB) Espanol (PDF, 2 MB)  
Check Your Vials poster English (PDF, 3 MB)    
Childhood Materials - - -
CHILD Profile Childhood Health Record, Birth-18 Years booklet English Espanol  
Immunizations: A Guide to Protecting Your Child brochure English Espanol Other languages
Lifetime Immunization Record Card English    
Plastic Sleeve for the Lifetime Immunization Record Card English    
Plain Talk About Childhood Immunizations, 6th Edition English (PDF, 634 KB) Espanol (PDF, 1 MB)  
Watch and Help Me Grow, Birth to 18 Months brochure English Espanol  
Watch and Help Me Grow, 18 Months to 3 Years brochure English Espanol  
Watch and Help Me Grow, 3 to 5 Years brochure English Espanol  
Childhood Immunization Coverage for Washington State 1995-2002 English (PDF, 2 MB)    
Childhood Immunization Coverage for Washington State 2003-2005 English (PDF, 166 KB)    
CHILD Profile bookmark English Espanol  
Cover Your Cough - - -
Brochure English    
Poster English Espanol  
"Do Not Unplug" sticker (3 x 3) English    
DTaP Materials      
DTaP poster (11 x 17) English (PDF, 699 KB) Espanol (PDF, 702 KB)  
DTaP poster tear-off pads English Espanol  
Flyer English (PDF, 85 KB) Espanol (PDF, 83 KB)  
Health Care Provider Tips to Increase DTaP Rates English (PDF, 176 KB)    
Provider Fact Sheet English (PDF, 671 KB)    
Flu Materials - - -
Childhood Flu Vaccine Identification Guide English (PDF, 2 MB)    
Flu Facts Countertop Display English (PDF, 2 MB)    
Flu Facts flyer English (PDF, 153 KB) Espanol (PDF, 169 KB) Other languages
Flu Poster Gallery (CDC) English Espanol  
Flu Parent Information flyer English (PDF, 207 KB) Espanol (PDF, 163 KB)  
Flu Shot promotional flyer English (PDF, 248 KB) Espanol (PDF, 203 KB)  
Flu Shot promotional placemat English (PDF, 304 KB)    
Flu Medicaid insert English (PDF, 348 KB) Espanol (PDF, 374 KB)  
Guess Who Needs a Flu Shot? flyer English (PDF, 579 KB)    
Top 3 Reasons to Get Your Flu Vaccine flyer English (PDF, 88 KB)    
Who Should Get Flu Vaccines? flyer English    
Will You Be Pregnant This Flu Season? poster (11 x 17) English (PDF, 877 KB) Espanol (PDF, 2 MB)  
Hepatitis Materials - - -
Asian Pacific Islander Task Force brochure English    
General Viral Hepatitis Information flyer English Espanol  
Hepatitis A & B Vaccines - Recommended Dosages and Schedules English    
Hepatitis B Birth Dose brochure English (PDF, 975 KB)   Other languages
Hepatitis B Facts: Testing and Vaccination English    
Hepatitis B: How to Protect Your Baby English Espanol Other languages
Hepatitis B information for adults and children from endemic areas flyer English   Other languages
Hepatitis B Prevention: What Asians and Pacific Islanders Need to Know     Other languages
Hepatitis B Prevention: Asians and Pacific Islanders Information posters English (PDF, 6 MB)   Other languages
Perinatal Hepatitis B brochure     Other languages
"Reporting of HBsAg+ Mothers is Now Required" sticker (2 x 3) English    
Start Protecting Your Baby at Birth with Hepatitis B Vaccine brochure English   Other languages
"This Baby Requires Hepatitis B Immunization" sticker (2 x 3) English    
Immunization Guidelines for the Use of State-Supplied Vaccines  July 1, 2009 English (PDF, 83 KB)    
Immunization Reminder/Recall Card English (PDF, 71 KB) Espanol (PDF, 70 KB)  
Keep On Track Chart 2006 English (PDF, 65 KB)    
Keep On Track Chart 2008 English (PDF, 23 KB)    
Keep On Track Chart 2009 English (PDF, 21 KB)    
Meningitis Materials - - -
Meningitis on Campus brochure English (PDF, 935 KB)    
Off to College? brochure English (PDF, 816 KB)    
Recommended Immunization Schedules - - -
2009 Childhood (Ages 0-6) English (PDF, 131 KB) Espanol  
2009 Adolescent (Ages 7-18) English (PDF, 114 KB) Espanol  
2009 Adult English (PDF, 539 KB) Espanol  
2008 Childhood (Ages 0-6) English (PDF, 705 KB) Espanol  
2008 Adolescent (Ages 7-18) English (PDF, 584 KB) Espanol  
2007-08 Adult English (PDF, 153 KB) Espanol  
Tdap Materials      
Adult poster (8.5 x 11) English (PDF, 75 KB)    
Child Care Provider flyer English (PDF, 165 KB) Espanol (PDF, 65 KB)  
Grandparents flyer English (PDF, 90 KB)    
Health Care Provider flyer English (PDF, 98 KB)    
Parents flyer English (PDF, 81 KB) Espanol (PDF, 2 MB)  
Think They're Too Old for Immunizations? Think Again, Tdap card for parents English (PDF, 803 KB)    
Think They're Too Old for Immunizations? Think Again, Tdap poster for parents English (PDF, 3 MB)    
Tetanus Materials - - -
Are You at Risk for Tetanus or Diphtheria? flyer English (PDF, 24 KB)    
Vaccine Handling and Storage Chart English    
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 English Espanol Other languages
Inactivated Influenza (Flu) English    
Live, Intranasal Influenza Vaccine (LAIV) English    
MMR (Measles/Mumps/ Rubella) English Espanol Other languages
Meningococcal English Espanol Other languages
Multiple Vaccines English    
Pneumococcal Conjugate (PCV7) English Espanol Other languages
Pneumococcal Polysaccharide (PPV23) English Espanol Other languages
Polio English Espanol Other languages
Rotavirus English Espanol Other languages
Shingles (Herpes Zoster) English Espanol Other languages
Td/Tdap English    
Varicella (Chickenpox) English Espanol Other languages
Vaccine Requirement Charts - - -
Child Care/Preschool Attendance 2009-2010 English (PDF, 56 KB) Espanol (PDF, 68 KB)  
Child Care/Preschool Attendance 2008-2009 English (PDF, 48 KB) Espanol (PDF, 49 KB)  
K-12 School Attendance 2009-2010 English (PDF, 57 KB) Espanol (PDF, 68 KB)  
K-12 School Attendance 2008-2009 English (PDF, 61 KB) Espanol (PDF, 61 KB)  
"Warning: Do Not Unplug" sticker (3.5 x 8) English    
Whooping Cough Materials - - -
Adult Tdap poster (8.5 x 11) English (PDF, 75 KB)    
Child Care Provider flyer English (PDF, 165 KB) Espanol (PDF, 65 KB)  
Grandparents flyer English (PDF, 90 KB)    
Health Care Provider flyer English (PDF, 98 KB)    
Parents flyer English (PDF, 81 KB) Espanol (PDF, 2 MB)  
WIC Easy IZ Guide English    

 

Last Update: 06/30/2009 04:32 PM