CHILD Profile
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Immunization Program |
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Immunization Program CHILD Profile |
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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) |
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| 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) |
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| 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 | ||
| 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) |
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| 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