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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 (Oct. 2008) English (PDF, 47 KB) Espanol (PDF, 116 KB) Other languages
Certificate of Immunization Status (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 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, 179 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 - - -
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 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)

 
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
Word, 2 MB
Publisher, 2 MB

   
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, 419 KB)

 

 

Will You Be Pregnant This Flu Season? poster (11 x 17) English Espanol  
Check Your Vials poster English    
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 Espanol  
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 and Espanol combined    
Cover Your Cough - - -
Brochure English    
Poster English Espanol  
"Do Not Unplug" sticker (3 x 3) English    
DTaP Materials      
DTaP Parent Fact Sheet - Help Your Baby Fight Pertussis! English Espanol  
DTaP poster (11 x 17) English (PDF, 699 KB) Espanol (PDF, 702 KB)  
DTaP Provider Fact Sheet English    
Tips to Increase 4th DTaP Rates English    
Flu (Seasonal) Materials - - -
2009-10 Seasonal Influenza Vaccine Pocket Information Guide English    
Centers for Disease Control and Prevention Flu Resources English Espanol  
Flu Facts Countertop Display English    
Flu Facts English (PDF, 153 KB) Espanol (PDF, 169 KB) Other languages
Flu Medicaid insert English (PDF, 348 KB) Espanol (PDF, 374 KB)  
Flu Parent Fact Sheet - Protect Your Child from Influenza English Espanol  
Flu Shot promotional placemat English (PDF, 304 KB)    
Who Should Get Flu Vaccines? English    
Will You Be Pregnant This Flu Season? poster (11 x 17) English Espanol  
Hepatitis Materials - - -
Asian Pacific Islander Task Force brochure English    
Hepatitis A & B Vaccines - Recommended Dosages and Schedules English    
Hepatitis B Facts: Testing and Vaccination English    
Hepatitis B information for adults and children from endemic areas flyer English   Other languages
Hepatitis B Prevention: Asians and Pacific Islanders Information posters     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    
What Asians and Pacific Islanders Need to Know About Hepatitis B English (PDF, 6 MB)   Other languages
Immunization Guidelines for the Use of State-Supplied Vaccines (Dec. 29, 2009) English (PDF, 102 KB)    
Immunization Reminder/Recall Card English Espanol  
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)    
Pneumococcal Polysaccharide Vaccination Pocket Guide English    
Recommended Immunization Schedules - - -
2008 Adolescent (Ages 7-18) English (PDF, 584 KB)    
2010 Adolescent (Ages 7-18) English    
2010 Adult English    
2008 Childhood (Ages 0-6) English (PDF, 705 KB)    
2010 Childhood (Ages 0-6) English    
Catch-up Schedule (Ages 4 months to 18 years) English    
Tdap Materials      
Tdap Adult poster (8.5 x 11) English    
Tdap Child Care Provider flyer English (PDF, 165 KB) Espanol (PDF, 65 KB)  
Tdap Grandparents flyer English (PDF, 90 KB)    
Tdap Health Care Provider flyer English (PDF, 98 KB)    
Tdap Parents flyer English (PDF, 81 KB) Espanol (PDF, 2 MB)  
Think They're Too Old for Immunizations? Think Again, Tdap fact sheet for parents English (PDF, 803 KB)    
Think They're Too Old for Immunizations? Think Again, Tdap poster for parents English (PDF, 3 MB)    
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 2009 H1N1 Influenza English Espanol Other languages
Inactivated Influenza (Flu) English Espanol Other languages
Live, Intranasal 2009 H1N1 Influenza English Espanol Other languages
Live, Intranasal Influenza Vaccine (LAIV) English Espanol Other languages
MMR (Measles/Mumps/ Rubella) English Espanol Other languages
Meningococcal English Espanol Other languages
Multiple Vaccines English Espanol Other languages
Pneumococcal Conjugate (PCV7) English Espanol Other languages
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 - Other languages
Varicella (Chickenpox) English Espanol Other languages
Vaccine Requirement Charts - - -
Child Care/Preschool Attendance 2008-2009 English (PDF, 48 KB) Espanol (PDF, 49 KB)  
Child Care/Preschool Attendance 2009-2010 English (PDF, 56 KB) Espanol (PDF, 68 KB)  
Child Care/Preschool Attendance 2010-2011 English (PDF, 81 KB)    
K-12 School Attendance 2008-2009 English (PDF, 61 KB) Espanol (PDF, 61 KB)  
K-12 School Attendance 2009-2010 English (PDF, 57 KB) Espanol (PDF, 68 KB)  
K-12 School Attendance 2010-2011 English (PDF, 80 KB)    
"Warning: Do Not Unplug" sticker (3.5 x 8) English    
Whooping Cough Materials - - -
Tdap Adult poster (8.5 x 11) English (PDF, 75 KB)    
Tdap Child Care Provider flyer English (PDF, 165 KB) Espanol (PDF, 65 KB)  
Tdap Grandparents flyer English (PDF, 90 KB)    
Tdap Health Care Provider flyer English (PDF, 98 KB)    
Tdap Parents flyer English (PDF, 81 KB) Espanol (PDF, 2 MB)  

 

Last Update: 01/21/2010 12:52 PM