Texas Department of State Health Services Home


   

Immunization Branch

DSHS Literature & Forms Online Order Form


Updated as of 8/12/13


NOW AVAILABLE FOR ORDERING:

     C-87 Intranasal Influenza VIS (English), CDC Rev 07/26/13
     C-93 Influenza VIS (English), CDC 07/26/13


Important information regarding your VIS order! The CDC has authorized the Department of State Health Services to deplete existing Vaccine Information Statement (VIS) stock prior to distributing the most current version when only minor updates have been made.



* = Required fields

Please use care as the shipping labels will contain exactly what you type into the cells. Double check your physical address and zip code to prevent costly returns. Thank You!

Order Date: 4/21/2014

First Name:*                     Last Name:*
  
Organization:*

Shipping Address 1:* (Can not ship to a PO BOX)

Shipping Address 2:

City:*                                       State:*    ZipCode:*
           
Phone:*

* Method of Shipment:
Your Acct.#

NOTE: Your Account number must be entered if you do not choose Standard Shipping. Leave this field blank for Standard Shipping.

Please allow 7 to 10 business days for delivery of all orders from DSHS Immunization's Warehouse.

Note: Please order from Immunization Branch-Literature and Forms once a month and only order up to the quantity limits. Thank you for your cooperation.

CNA = Currently Not Available

Available Online Only = Out of stock - Product is available as PDF for download and for customers to make copies to distribute while out of stock.

Note: May 1, 2006, the Texas Department of State Health Services, Immunization Branch, Literature and Forms no longer accepts back orders for publications currently not available due to revisions/replenishments.  Please check with the Immunization Branch, Literature and Forms at (800) 252-9152 extension 6530 on the availability of publications not available. 

Stock#

Title

Qty

6-14

2013-2014 Minimum State Vaccine Requirements for Texas School Entrance/Attendance (Bilingual, 8.5 x 11, 4pp)View Item Here / Download (Rev 03/2013)
Valid for School Year 2013-2014 

6-15

2013-2014 Minimum State Vaccine Requirements for Texas Child-Care Facilities (Bilingual, 8.5 x 11, 4pp)View Item Here / Download (Rev 04/2013)
Valid for School Year 2013-2014 

6-26

Recommendation for Handling & Storage of Selected Biologicals-Booklet. (English) View Item Here / Download (Rev. 11/07)  

Available Online Only

6-26P

Recommendation for Handling & Storage of Selected Biologicals-Poster 17" x 33 1/2" (English)
View Item Here (Rev. 02/08)  

Maximum Limit: 15

6-27P

"How to Administer Injections" Poster - 13" x 27" (Bilingual) View Item Here (Rev. 09/07) 

Maximum Limit: 15

6-30

Communicable Disease Chart & Notes for Schools & Child Care Center Poster - 22" x 30" (English) (Rev. 03/13) 

Maximum Limit: 100

6-36

Fee for Vaccine Administration-Poster - 17" x 22" (English) View Item Here (Rev.08/09) 

Available Online Only

6-61

Guide to Contraindications-Poster - 19" x 27" (English) View Item Here (Rev. 04/07) 

CNA

6-67

"Story of Shots"-Booklet (English) View Item Here / Download (Rev. 06/09) 

CNA

6-67A

"Story of Shots"-Booklet (Spanish) View Item Here / Download (Rev. 06/09) 

CNA

6-102

Texas Vaccines For Children-Physician Recruitment Packet. (English) Please contact your Health Service Region (HSR) representative to obtain a copy or download from our website. View Item Here / Download (Rev. 01/14) 

Available Online Only

6-103

Texas School Immunization Law (English) View Item Here / Download (Rev. 07/12)  

6-104

Recommended Adult Immunization Schedule UNITED STATES (11x17)* 2014 (English) 2-pages View Item Here / Download (Rev. 02/14) 

Available online only

6-104A

Recommended Adult Immunization Schedule - UNITED STATES * 2014 (Spanish) (Rev. 02/2014) 

CNA

6-104L

Recommended Adult Immunization Schedule - UNITED STATES * 2013 Laminated (English) View Item Here / Download (Rev. 02/13) 

Available Online Only

6-104PSS

Recommended Adult Immunization Pocket Size Schedule - UNITED STATES * 2013 (English)View Item Here / Download (Rev. 02/13) 

Available Online Only

6-105

Recommended Immunization Schedule for Persons Aged 0 through 18 Years - United States (11" x 8 1/2")* 2014 (English) 8-pages View Item Here / Download (Rev. 02/14) 

Available Online Only

6-105A

Recommended Childhood and Adolescent Immunization Schedule - United States * 2014
(Spanish) (DSHS Rev. 02/14) 

CNA

6-105L

Recommended Childhood and Adolescent Immunization Schedule - United States * 2013 Laminated
(English) View Item Here / Download 6-page tri-fold, color version (DSHS Rev. 02/13) 

Available Online Only

6-105PSS

Recommended Childhood & Adolescent Immunization Pocket Size Schedule - UNITED STATES * 2013 (English)View Item Here / Download (Rev. 02/13) 

Available Online Only

6-180

Refrigerator Warning Signs-(Bilingual) (for vaccine storage) View Item Here / Download (Rev. 06/2011) 

Maximum Limit: 50

6-202

"Love Them & Protect Them"-ImmTrac Brochure (Bilingual) View Item Here / Download (Rev. 09/13) 

Maximum Limit: 500

6-202P

"Love Them & Protect Them"-ImmTrac Poster - 11" x 25 3/8" (Bilingual)
View Item Here (Rev. 05/05) 

Maximum Limit: 25

6-205

"These Are The Times You'll Want To Remember"-Pamphlet (English) View Item Here / Download
(Rev. 10/13) 

Maximum Limit: 500

6-205A

"These Are The Times You'll Want To Remember"-Pamphlet (Spanish) View Item Here / Download
(Rev. 12/10) 

Maximum Limit: 500

6-214

"These Are The Times You'll Want To Remember"-Poster - 18 1/2" x 23"(English) View Item Here 

CNA

6-216

Liability Protection for Children's Immunization Providers (English) View Item Here / Download (Rev. 08/09) 

Available Online Only

6-217

"Your Kid's Ticket to a Healthier Life" Brochure (Bilingual) View Item Here / Download (Rev. 11/10) 

Available Only Only

6-217M

"Your Kid's Ticket to a Healthier Life" Magnet (Bilingual) (Rev. 02/11) 

CNA

6-218

"Protect Texas Children" Brochure (English)View Item Here / Download (Rev. 06/13) 

Maximum Limit: 250

6-250

General Recommendations on Immunization. Morbidity and Mortality Weekly Report (MMWR) January 28, 2011/Vol. 60/No. 2. (Rev. 01/11) (English) View Item Here / Download 

Available Online Only

6-251

Standards for Child and Adolescent Immunization Practices. (English) View Item Here / Download (Rev. 07/04) 

Available Online Only

6-252

Standards for Adult Immunization Practices - (CDC Rev. 05/08) (English) View Item Here / Download 

Available Online Only

6-306

"Every Dose Counts 4th DTaP"-Bilingual Poster - 18" x 25" (Rev. 03/07) View Item Here 

Maximum Limit: 25

11-10373

TVFC-"Stop Vaccine Fraud and Abuse" Brochure (English) View Item Here / Download (Rev. 08/01) 

Available Online Only

11-11117

"Vaccines Provide Protection When Your Baby Needs It Most"-Brochure (Bilingual)
View Item Here / Download (Rev. 04/2012) 

Maximum Limit: 500

11-11166

"Vaccines Provide Protection When Your Baby Needs It Most"-Poster (Bilingual)
View Item Here (Rev. 04/07) 

Maximum Limit: 25

11-11424

"Pertussis (Whooping Cough) Fact Sheet" (Bilingual) View Item Here / Download (Rev. 02/06) 

Available Online Only

11-11444

"Hepatitis B Vaccine Can Save your Baby's Life" (English)
View Item Here / Download (Rev. 07/12) 

11-11444A

"Hepatitis B Vaccine Can Save your Baby's Life" (Spanish)
View Item Here / Download (Rev. 01/13) 

Available Online Only

11-12155

"Giving All the Doses" Chart 11 x 17 (English) View Item Here / Download (Rev 04/2011) 

Maximum Limit: 25

11-12798

"Protect Your Entire Family Against Pertussis", Flyer 3 7/8" x 8 7/8" (Bilingual) View Item Here / Download 

Available Online Only

11-12811

"Little Kids Get the Flu Too!!" Brochure (English) View Item Here / Download (Rev 10/2013) 

Maximum Limit: 250

11-12811A

"Little Kids Get the Flu Too!!" Brochure (Spanish) View Item Here / Download (Rev. 05/2011) 

Maximum Limit: 250

11-12812

Influenza (The Flu) Fact Sheet for Child-Care Settings (Bilingual) View Item Here / Download (Rev 07/2013) 

Maximum Limit: 250

11-12815

Vaccines Full Protection Magnet (English) 10 1/2 x 3 1/4" View Item Here (Rev.03/11) 

Maximum Limit: 125

11-12815A

Vaccines Full Protection Magnet (Spanish) 10 1/2 x 3 1/4" View Item Here (Rev.03/2011) 

Maximum Limit: 125

11-12816

"Comfort Measures" Tear-off Sheets (Pads of 50 Sheets ea.) (Bilingual) View Item Here / Download (Rev. 10/07) 

Maximum Limit: 5

11-12816P

"Comfort Measures" Poster - 19" x 25" (Bilingual) View Item Here (Rev. 10/07) 

Maximum Limit: 25

11-12848P

"Good Health Can Last a Lifetime" Poster 17" x 24" - (Bilingual) View Item Here (Rev. 08/13) 

Maximum Limit: 25

11-12849

Adolescent Immunization Program Brochure (Bilingual) (Rev. 02/13) 

Maximum Limit: 250

11-12851

Vaccinate For Life Brochure View Item Here / Download (Bilingual) Rev 08/2011 

Available Online Only

11-12853P

Vaccinate for Life Poster - 11" x 17" - (Bilingual) (Rev. 05/2013) 

Maximum Limit: 25

11-13079

First Responders ImmTrac Brochure - (English) View Item Here / Download (Rev. 01/09) 

Maximum Limit: 50

11-13080P

First Responders Immtrac Poster - 22" x 16" - (English) View Item Here (Rev. 11/08) 

Maximum Limit: 25

11-13132

"Good Health Can Last a Lifetime" Adolescent, Bookmark Bilingual View Item Here / Download Rev. 08/2013 

Maximum Limit: 250

11-13175M

Immunization Schedule Magnet (BABY BEBA - Photo Frame Magnet)
5 1/2" x 8 1/2"
(Bilingual) View Item Here Rev 03/2011 

CNA

11-13231

"Vaccines & Me" Coloring Calendar 2014-2015 (Bilingual) Rev. 12/2013 

Maximum Limit: 500

11-13539

ImmTrac Lifetime Registry Brochure (Bilingual) View Item Here / Download (Rev 05/2011) 

Maximum Limit: 250

11-13547P

"Recommended Vaccines for Children birth to 12 Years of Age" Poster 22" x 17" (Bilingual) View Item Here / Download (Rev 01/2011) 

Maximum Limit: 10

11-13548

Vaccines Full Protection Banner (Bilingual) 17" x 54" View Item Here (Rev 03/2011)
English version 11-13548 Front Side
Spanish version 11-13548A Back Side 

11-13643

Protect Two from the Flu Brochure View Item Here/Download (Bilingual) Rev 06/2011 

Maximum Limit: 500

11-13645P

Protect Two from the Flu Poster - Anglo View Item Here (English) Rev 06/2011 

Maximum Limit: 25

11-13645P-2

Protect Two from the Flu Poster - African American View Item Here (English) Rev 06/2011 

Maximum Limit: 25

11-13645PA

Protect Two from the Flu Poster - Latino View Item Here (Spanish) Rev 06/2011 

Maximum Limit: 25

11-13654P

Pertussis Cocooning Poster (Bilingual)View Item Here Rev 04/2013 

Maximum Limit: 25

11-13655

Pertussis Cocooning Brochure View Item Here / Download (Bilingual) Rev 07/2011 

Maximum Limit: 500

11-13656

Pertussis Cocooning Handbook View Item Here / Download (English) Rev 08/2011 

Available Online Only

11-13661M

Vaccines Aren't Just for Kids (Black Magnet) View Item Here (English) Rev 12/2011 

CNA

11-13661MA

Vaccines Aren't Just for Kids (Black Magnet) View Item Here (Spanish) Rev 12/2011 

Maximum Limit: 125

11-13662

Vaccinator Pocket Guide 

CNA

11-13707

ImmTrac Isn't Just For Kids Brochure View Item Here / Download (English) Rev 12/2011 

Maximum Limit: 500

11-13707A

ImmTrac Isn't Just For Kids Brochure View Item Here / Download (Spanish) Rev 04/2012 

Maximum Limit: 500

11-13707P

ImmTrac Isn't Just For Kids Poster-African American Adults View Item Here (Bilingual) Rev 12/2011 

Maximum Limit: 25

11-13707P-2

ImmTrac Isn't Just For Kids Poster-Anglo Adults View Item Here (Bilingual) Rev 12/2011 

Maximum Limit: 25

11-13707P-3

ImmTrac Isn't Just For Kids Poster-Hispanic Adults View Item Here (Bilingual) Rev 12/2011 

Maximum Limit: 25

11-13708

ImmTrac Is For you, Too Brochure View Item Here / Download (English) Rev 12/2011 

Maximum Limit: 500

11-13708A

ImmTrac Is For you, Too Brochure View Item Here / Download (Spanish) Rev 04/2012 

Maximum Limit: 500

11-13708P

ImmTrac Is For You, Too Poster-Young Adult View Item Here (Bilingual) Rev 12/2011 

Maximum Limit: 25

11-13710

Fight the Flu Brochure View Item Here(English) Rev 10/2012 

Maximum Limit: 500

11-13710A

Fight the Flu Brochure View Item Here(Spanish) Rev 10/2012 

Maximum Limit: 500

11-13710P

Fight The Flu Poster View Item Here (Bilingual) Rev 12/2011 

Maximum Limit: 25

11-13711

Halt HPV Brochure View Item Here (English) Rev 04/2012 

Maximum Limit: 500

11-13711A

Halt HPV Brochure View Item Here (Spanish) Rev 04/2012 

Maximum Limit: 500

11-13711P

Halt HPV Poster View Item Here (Bilingual) Rev 12/2011 

Maximum Limit: 25

11-13712

Meningitis Brochure View Item Here (English) Rev 04/2012 

Maximum Limit: 500

11-13712A

Meningitis Brochure View Item Here (Spanish) Rev 08/2012 

Maximum Limit: 500

11-14008

Prevent Pertussis Brochure View Item Here / Download (Bilingual)Rev 1/2013 

Maximum Limit: 500

11-14009P

Now is the Time to Prevent Whooping Cough Poster-Anglo Adults View Item Here / Download (English) Rev 11/2012 Prevent Pertussis Poster 

Maximum Limit: 50

11-14009P-1

Now is the Time to Prevent Whooping Cough Poster-Africian Adults View Item Here / Download (English) Rev 11/2012 Prevent Pertussis Poster 

Maximum Limit: 50

11-14009P-2

Now is the Time to Prevent Whooping Cough Poster-Hispanic Adults View Item Here/Download (English (English) Rev 11/2012 Prevent Pertussis Poster 

Maximum Limit: 50

11-14015P

"Fight The Flu"-Poster - 18 " x 25" View Item Here / Download (Bilingual) 

Maximum Limit: 50

11-14106

First Responders- Get Vaccinated Brochure View Item Here / Download Rev 10/2013 

Maximum Limit: 500

11-14106P

First Responders- Get Vaccinated Poster 18 x 24 View Item Here / Download Rev 10/2013 

Maximum Limit: 25

11-14120

Hepatitis B: What Hospitals Need to Do to Protect Newborns View Item Here / Download Booklet (English) Rev. 11/2013 

Maximum Limit: 100

11-14121

Hepatitis B: Birth Dose Honor Roll View Item Here / Download (English) Rev. 11/2013 

Maximum Limit: 100

11-14168

The Germ Patrol Book- All About Shots for Tots.. And Big Kids, Too! (English) Rev. 2/2014 

CNA

11-14175

Pertussis Information Sheet View Item Here / Download (English) Rev. 03/2014 

Available Online Only

11-14178

Pertussis TMP-SMZ (Bactrim, Septra, SMX/TMP) for Pertussis PEP Fact Sheet View Item Here / Download (English) Rev. 03/2014 

Available Online Only

11-14179

Azithromycin for Pertussis PEP Fact Sheet View Item Here / Download (English) Rev. 03/2014 

Available Online Only

C-7

"ImmTrac"- Immunization Registry Consent Form (Bilingual) - View Item Here / Download (Rev. 05/2012)
Birth Registrars DO NOT use this form. 

Maximum Limit: 500

C-8

ImmTrac "Withdrawal of Consent & Confirmation Form" View Item Here / Download (Bilingual) Rev 02/2011 

Available Online Only

C-9

Documenting History of Varicella (Chickenpox) Illness Form View Item Here / Download (Bilingual) (Rev. 05/09) 

Maximum Limit: 500

C-10

Texas VFC-Patient Eligibility Screening Form (Bilingual) View Item Here / Download (Rev. 11/2012) 

Available Online Only

C-11

School/Daycare Immunization Record (English) View Item Here / Download (Rev. 01/13) 

Maximum Limit: 500

C-33

Monthly Vaccine Report-Form (English) Please contact your Health Service Region (HSR) representative to obtain a copy or download from our website. View Item Here / Download (Rev. 02/10) 

Available Online Only

C-61

Adult Vaccination Reminder Card (Bilingual) View Item Here / Download (Rev. 04/09) 

Maximum Limit: 250

C-62

Adolescent Vaccination Reminder Card (Bilingual) View Item Here / Download (Rev. 04/09) 

Maximum Limit: 250

C-63

Clinic Delinquent Reminder Card (Non Postage) (Bilingual) View Item Here / Download (Rev. 05/08) 

Maximum Limit: 250

C-64

"Vaccines Build Your Child's Health" Reminder Postcard (Bilingual) View Item Here / Download (Rev. 05/08) 

Available Online Only

C-68

Biological Order/Transfer Form (English) Please contact your Health Service Region (HSR) representative to obtain a copy or download from our website: View Item Here / Download (Rev. 08/11) 

Available Online Only

C-69

Texas Vaccine Loss Report (English) View Item Here / Download (Rev. 12/07)  

Available Online Only

C-76

Vaccine Adverse Event Reporting System-Form (English) View Item Here / Download (Rev. 07/07) 

Maximum Limit: 50

NOTICE

Important information regarding your VIS order! The CDC has authorized the Department of State Health Services to deplete existing Vaccine Information Statement (VIS) stock prior to distributing the most current version when only minor updates have been made. 

.

C-85

Pneumococcal Conjugate Vaccine-Vaccine Information Statement (English) (CDC Interim Rev. 2/27/13)* Available online: VIS | Addendum 

Maximum Limit: 500

C-85A

Pneumococcal Conjugate Vaccine-Vaccine Information Statement (Spanish) (CDC Interim Rev. 02/27/13) * Available online: VIS | Suplemento 

Maximum Limit: 500

C-86

Pneumococcal Polysaccharide Vaccine-Vaccine Information Statement (English) (CDC Rev. 10/06/09) * Available online: VIS | Addendum 

Maximum Limit: 500

C-86A

Pneumococcal Polysaccharide Vaccine - Vaccine Information Statement (Spanish) (CDC Rev. 10/06/09) * Available online: VIS | Suplemento 

Maximum Limit: 500

C-87

Live, Intranasal Influenza Vaccine - Vaccine Information Statement (English) (CDC Interim Rev. 07/26/2013)* Available online: VIS | Addendum 

Maximum Limit: 500

C-87A

Live, Intranasal Influenza Vaccine - Vaccine Information Statement (Spanish) (CDC Rev. 07/26/2013)* Available online: VIS | Addendum 

Maximum Limit: 500

C-90

Polio Vaccine (IPV) - Vaccine Information Statement (English) (CDC Rev. 11/08/2011)
* Available online: VIS | Addendum
 

Maximum Limit: 500

C-90A

Polio Vaccine (IPV) - Vaccine Information Statement (Spanish) CDC (Rev. 11/08/11)
* Available online: VIS | Suplemento
 

Maximum Limit: 500

C-91

Diphtheria, Tetanus, and Pertussis Vaccine - Vaccine Information Statement (English) (CDC Rev. 05/17/07) * Available online: VIS | Addendum 

Maximum Limit: 500

C-91A

Diphtheria, Tetanus, and Pertussis Vaccine - Vaccine Information Statement (Spanish) (CDC Rev. 05/17/07) * Available online: VIS | Suplemento 

Maximum Limit: 500

C-92

Measles, Mumps, and Rubella Vaccine - Vaccine Information Statement (English) (CDC Interim Rev. 04/20/12) * Available online: VIS | Addendum
 

Maximum Limit: 500

C-92A

Measles, Mumps, and Rubella Vaccine - Vaccine Information Statement (Spanish) (CDC Rev. 04/20/12) * Available online: VIS | Suplemento
 

Maximum Limit: 500

C-93

Influenza Vaccine - Vaccine Information Statement (English) (CDC Interim Rev. 07/26/2013)
* Available online: VIS | Addendum 

Maximum Limit: 500

C-93A

Influenza Vaccine - Vaccine Information Statement (Spanish) (CDC Rev. 07/26/2013)
* Available online: VIS | Suplemento 

Maximum Limit: 500

C-94

Tetanus, Diphtheria (Td)Vaccine - Vaccine Information Statement (English)
(CDC Interim Rev. 2/04/14)
* Available online: VIS | Addendum 

Maximum Limit: 500

C-94A

Tetanus, Diphtheria (Td) or Tetanus, Diphtheria, Pertussis (Tdap) Vaccine - Vaccine Information Statement (Spanish)
(CDC Interim Rev. 1/24/12)
* Available online: VIS | Suplemento 

Maximum Limit: 500

C-95

Hepatitis A Vaccine - Vaccine Information Statement (English) (CDC Rev. 10/25/2011)
* Available online: VIS | Addendum
 

Maximum Limit: 500

C-95A

Hepatitis A Vaccine - Vaccine Information Statement (Spanish) (CDC Rev. 10/25/11
* Available online: VIS | Suplemento 

Maximum Limit: 500

C-96

Meningococcal Vaccine - Vaccine Information Statement (English) (CDC Interim Rev. 10/14/11)
* Available online: VIS | Addendum 

Maximum Limit: 500

C-96A

Meningococcal Vaccine - Vaccine Information Statement (Spanish) (CDC Interim Rev. 10/14/11)
* Available online only: VIS | Suplemento 

Maximum Limit: 500

C-97

Chickenpox Vaccine - Vaccine Information Statement (English) (CDC Interim Rev. 03/13/08)
* Available online: VIS | Addendum 

Maximum Limit: 500

C-97A

Chickenpox Vaccine - Vaccine Information Statement (Spanish) (CDC Interim Rev. 3/13/08)
* Available online: VIS | Suplemento 

Maximum Limit: 500

C-99

Rabies Vaccine - Vaccine Information Statement (English) (CDC Rev. 10/06/09)
* Available online: VIS | Addendum 

Maximum Limit: 250

C-99A

Rabies Vaccine - Vaccine Information Statement (Spanish) (CDC Rev. 10/06/09)
* Available online only: VIS | Suplemento 

Maximum Limit: 250

C-100

Vaccine Information Documentation (Bilingual) View Item Here / Download (Rev. 11/10)  

Maximum Limit: 1000

C-102

Personal Immunization Record (Bilingual) View Item Here / Download (Rev. 11/2010) 

Maximum Limit: 1000

C-103

My Child's Health Record (Bilingual) View Item Here / Download (Rev. 08/09) 

Maximum Limit: 250

C-104

Adult Immunization Record Card (Bilingual) View Item Here / Download (Rev. 08/2013) 

Maximum Limit: 1000

C-105

Temperature Recording Form (English) View Item Here / Download (Rev. 01/05) 

Available Online Only

C-106

Hepatitis B Vaccine - Vaccine Information Statement (English) (CDC Interim Rev. 02/02/12)
* Available Online: VIS | Addendum

Maximum Limit: 500

C-106A

Hepatitis B Vaccine - Vaccine Information Statement (Spanish) (CDC Interim Rev. 02/02/12)
* Available Online: VIS | Suplemento
 

Maximum Limit: 500

C-108

Haemophilus Influenzae Type b Vaccine (Hib) - Vaccine Information Statement (English) (CDC Interim Rev 02/04/14)
* Available Online: VIS | Addendum 

Maximum Limit: 500

C-108A

Haemophilus Influenzae Type b Vaccine (Hib) - Vaccine Information Statement (Spanish) (CDC Rev. 12/16/98)
* Available Online: VIS | Suplemento 

Maximum Limit: 500

C-109

Tetanus, Diphtheria, Pertussis VIS (English) (CDC Interim Rev. 5/09/2013)
* Available Online: VIS | Addendum
 

Maximum Limit: 500

C-109A

Tetanus, Diphtheria, Pertussis VIS (Spanish) (CDC Interim Rev. 5/09/2013)
* Available Online: VIS | Addendum
 

Maximum Limit: 500

C-110

Rotavirus Vaccine - Vaccine Information Statement (English) (CDC Interim Rev. 08/26/13)
* Available Online: VIS | Addendum 

Maximum Limit: 500

C-110A

Rotavirus Vaccine - Vaccine Information Statement (Spanish) (CDC Interim Rev. 08/26/13)
* Available Online Only: VIS | Suplemento 

Maximum Limit: 500

C-111

Human Papillomavirus Vaccine (HPV-Cervarix) - Vaccine Information Statement (English) (CDC Interim Rev. 5/3/2011)
* Available Online: VIS | Addendum
 

Maximum Limit: 500

C-111A

Human Papillomavirus Vaccine (HPV-Cervarix) - Vaccine Information Statement (Spanish) (CDC Interim Rev. 05/03/11)
* Available Online: VIS | Suplemento
 

Maximum Limit: 500

C-112

Shingles Vaccine - Vaccine Information Statement (English) (CDC Interim Rev. 10/06/09)
* Available Online: VIS | Addendum
 

Maximum Limit: 500

C-112A

Shingles Vaccine - Vaccine Information Statement (Spanish) (CDC VIS Rev. 10/06/09)
* Available Online: VIS | Suplemento
 

Maximum Limit: 500

C-113

Multi Vaccine - Vaccine Information Statement (English) (CDC Interim Rev. 11/16/12)
* Available Online: VIS | Addendum
 

Maximum Limit: 500

C-113A

Multi Vaccine - Vaccine Information Statement (Spanish) (CDC Interim Rev. 11/16/12)
* Available Online: VIS | Addendum
 

Maximum Limit: 500

C-114

Human Papillomavirus Vaccine (HPV-Gardasil) - Vaccine Information Statement (English) (CDC Interim Rev. 05/17/2013)
* Available Online: VIS | Addendum
 

Maximum Limit: 500

C-114A

Human Papillomavirus Vaccine (HPV-Gardasil) - Vaccine Information Statement (Spanish) (CDC Interim Rev. 05/17/13) Available Online: VIS | Addendum 

Maximum Limit: 500

C-115

Measles, Mumps, Rubella, and Varicella (English) (CDC Interim Rev. 05/21/2010)
* Available Online: VIS | Addendum
 

Maximum Limit: 500

C-115A

Measles, Mumps, Rubella, and Varicella (Spanish) (CDC Interim Rev. 05/21/2010)
* Available Online: VIS | Addendum
 

Maximum Limit: 500

HALLMARK_CARD_KIT

Peek-a-boo!
Hallmark Card with envelope.
 

Maximum Limit: 500

DV0499

Keep children on track with ImmTrac - DVD. English/Spanish. Rev 06/09. 

Maximum Limit: 3

DV-0531

First Responders: Keep Track with ImmTrac - DVD. English. Rev 08/09.
Only to be used for educating First Responder audiences. 

Maximum Limit: 3

EpiVPD

Epidemiology of Vaccine Preventable Diseases. Rev 2014. 

CNA

F11-11443

"Provider Withdrawal Form" (English) Please contact your Health Service Region (HSR) representative to obtain a copy or download from our website. View Item Here / Download (Rev. 11/08) 

Available Online Only

F11-11936

ImmTrac Newborn Consent Form (ImmTrac NB-2) - View Item Here / Download (Bilingual) (Rev.09/27/12)
For use by Birth Registrars ONLY. 

Maximum Limit: 1000

F11-12842

Adult Safety Net Eligibility Screening Form (Bilingual) View Item Here / Download (Rev. 11/13) 

Available Online Only

F11-12955

ImmTrac First Responder/Family Member Request Form (Bilingual)
View Item Here / Download
(Rev. 05/08/12) 

Maximum Limit: 200

F11-12956-P

ImmTrac Disaster Information Retention Consent Form (Bilingual) View Item Here / Download (Rev. 09/12/08) NOTE: This is NOT a poster. 

Maximum Limit: 500

F11-13078

First Responders ImmTrac Wallet Card - (English) View Item Here / Download (Rev. 11/08) 

Maximum Limit: 500

F11-13366

ImmTrac Adult Consent Form - (Bilingual) View Item Here / Download (Rev 05/2012) 

Maximum Limit: 250

F11-13500

ImmTrac Site Agreement and Confidentiality Statement Update/Renewal Form (English)
View Item Here / Download
(Rev. 11/2011) 

Available Online Only

F11-13678P

Immunization Clinic Poster View Item Here / Download (English) Rev 08/2011 

Maximum Limit: 25

F11-13788

Patient Referral Form for Vaccination (English)
View Item Here / Download
(Rev. 12/11) 

Available Online Only

F11-14174

Pertussis PEP Client Evaluation Form View Item Here / Download (English) Rev. 03/2014 

Available Online Only

F11-14176

Pertussis PEP Medication Contraindications and Precautions Checklist View Item Here / Download (English) Rev. 03/2014 

Available Online Only

F11-14177

Pertussis PEP Eligibility Criteria Checklist View Item Here / Download (English) Rev. 03/2014 

Available Online Only

1605

TVFC Small Vaccine Trays (White 6 3/8" x 5" x 2 1/8") (24 in a carton) 

CNA

1607

TVFC Long Vaccine Trays (White 12 1/2" x 5" x 2 1/8") (24 in a carton) 

CNA

11-13338

Flu Fighters Activity BookView Item Here / Download (Bilingual) Rev. 01/2010 

Maximum Limit: 100

FLU_FIGHTERS

Flu Fighters Videos for the 2010 H1N1 Event - DVD (English/Spanish) 

Maximum Limit: 50

Please review your order. Once you click the Submit button your order will be placed. If you submitted by mistake, please call 1-800-252-9152, extension 3711 immediately to amend your order.

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Last Updated August 12, 2013

 

 

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