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 | 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) |
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| 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 | ||
| 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) |
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| 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