Download paper version of Immunization Materials Request Form

Download paper version of Seasonal Immunization Materials Request Form

Please indicate the quantities for each language and type of material you would like to receive.

Allow 2 weeks for delivery.  There is no charge for this service, however all orders must have a valid San Francisco address.

Agency Name		Phone		Fax
Contact Name		Email
Mailing Address	San Francisco, CA			ZIP

Clinic and Provider Materials

Material	Code	Language	Quantity
Adult Immunization Record   for medical chart, 8.5 x 11	542	English
Anatomic Sites for Immunization   poster 13 x 33.5	685	English
CA Immunization Record   yellow card	75	English & Spanish
CA Immunization Record   yellow card	75	English & Chinese
GOAL!   preteen reminder postcard, bilingual, HIPPA compliant	863	English & Spanish
Immunization Techniques Video   35 minutes	712	English
		Spanish
Immunization Timing   8.5 x 11, laminated, colored boxes	395	English
It's time!   reminder postcard / bilingual, HIPPA compliant	794	English & Spanish
Lab Coat Pediatric Timing Schedule   color, laminated, 3.5 x 8.5	496	English
Off Schedule   deferred vaccine reminder postcard / trilingual, HIPPA compliant	795	English, Spanish & Chinese
Pediatric Immunization Record   for medical chart, 8.5 x 11	542	English
Plastic sleeves   for yellow card	76	English
Recommended Adult Immunization Schedule	746	English
Recommended Childhood & Adolescent Immunization Schedule	662	English
VFC Refrigerator Temperature Log   two color (12 sheets to a pad)	682	English
2007 Physician's Guide to Hepatitis B   developed by Asian Liver Ctr. @ Stanford Univ.		English

Flu-specific Materials

Material	Code	Language	Quantity
Babies Need You To Protect Them From The Flu   flyer, 8.5 x 11	823	English
Emery boards   "Somebody Needs a Flu Shot"	732	English
		Spanish
Flu Home Care Guide   small booklet	sfdph	English
Guess Who Needs a Flu Shot?   6 mos. to 18 yrs., bilingual reminder postcard	781	English & Spanish
Guess Who Needs a Flu Shot?   6 mos. to 18 yrs., bilingual static cling	782	English & Spanish
Health Care Worker Flu   flyer, 8.5 x 11	801	English
		Spanish
Influenza Vaccine Identification Guide   chart, 8.5 x 11	859	English
Latina 50+ Flu Campaign   static cling, 8.5 x 11	773	Spanish
Over 50? Somebody Needs a Flu Shot   static cling, 6 x 8	740	English
Protect Against Flu & Whooping Cough   flyer, 8.5 x 11	874	English
Ways to Protect Yourself from Flu & Pandemic Flu   brochure	853	English
3 Reasons to Get Your Flu Vaccine   poster, 18 x 24	741	English
		Spanish

Patient / Parent Materials

Material	Code	Language	Quantity
Anyone Can Get Hepatitis B   brochure for young adults	747	English
		Spanish
		Chinese
Comfort Measures   (Be There for Your Child...) 50/tablet, 8.5 x 11, bilingual	686	English & Spanish
Got a Preteen Daughter?   HPV brochure	852	English
Got a Preteen Daughter?   HPV brochure	852	Spanish
GOT IZ'D   license plate style sticker, 250/roll	632	English
Guide to VPDs in Adolescents   comprehensive brochure	SA	English
		Spanish
Guide to VPDs in Adults   comprehensive brochure	SA	English
Guide to VPDs in Children   comprehensive brochure	SA	English
		Spanish
Hepatitis A and Hepatitis B   targets MSM, brochure		English
Hepatitis B & Moms-to-Be   brochure	ALC	English
		Chinese
		Korean
		Vietnamese
		Tagalog
		Lao
I'm Loved   bear sticker, 500/roll	449	English
		Spanish
Know HBV   hep B chronic infection & API brochure	ALC	English
		Chinese
		Korean
		Vietnamese
		Tagalog
		Lao
Off to College?   flyer about meningococcal disease & vaccine, 8.5 x 11	688	English
Prevent Hepatitis A   brochure (all ages)	CDC	English
Protect Your Baby from Whooping Cough   for adults, about Tdap, 8.5 x 11	817	English
		Spanish
Protect Your Little One with Baby Shots   brochure, with checklist	234	English
		Spanish
Schedule of Childhood Immunizations   clear sticker, 500/roll, bilingual	332	English & Spanish
Vaccines for Adults 50+   brochure	260	English
		Spanish
What Parents Should Know about Whooping Cough   8.5 x 11, bilingual		English & Spanish

Respiratory Disease Prevention Materials

Material	Code	Language	Quantity
Cover Your Cough   bilingual table tent; 4.25 x 11 folder	784	English & Spanish
Germ-Free Zone   bilingual static cling, 8.5 x 11 (for classrooms)	789	English & Spanish
Health Alert   (stop spread of germs information) bilingual static cling, 8.5 x 11	783	English & Spanish
Infect Me Not - Healthy Habits   brochure	sfdph	English
Infect Me Not   magnet, 6 x 3	sfdph	English
Stop Disease   (stop spread of germs information) multilingual static cling, 6 x 8	780	English, Spanish & Chinese
Wash Your Hands ~ Protect yourself. Prevent disease!   multilingual static cling, 6 x 9	819	English, Spanish & Chinese

School and Childcare Materials

Material	Code	Language	Quantity
California Immunization Handbook   Blue Book	365	English
California School Immunization Record   Blue Card	101	English
Pre-school / Family Child Care Windows   Pink (for reading blue card)	408	English
		Spanish
School Windows   Purple (for reading blue card)	528	English

Submit Your Request

VACCINE INFORMATION STATEMENTS: Federal Law mandates that Vaccine Information Statements (VISs) be provided every time an immunization is administered.  VISs are available in multiple languages at www.immunize.org/vis/, or by calling 1-800-PIK-VIPS.

The SFUSD School Health Program provides health forms and Blue Cards for its schools.  Call 415-575-5712 or 242-2615.