Dear Parent,

The Riverside County Community Health Agency, Department of Public Health will be offering the 2nd vaccination of Pandemic H1N1 vaccine to school age children less than 10 years of age. Two vaccines are required   to fully protect them against the pandemic (H1N1) influenza (flu). The Pandemic H1N1 2009/FluMist or Injectable vaccinations will be offered FREE.  If a first vaccination has already been given through the school, a consent form is not needed.  However, if this is a first visit, we will not vaccinate your child unless we receive a completed and signed Consent and Health Insurance Portability and Accountability Act (HIPAA) Form. The vaccination is FREE. Please complete the Consent Form and return it March 17, 2010 at the vaccination clinic. 

The following is required for first visits: 

    1.  A Consent Form allowing your child to be vaccinated against influenza (flu) at school.  Please complete, sign, and return to the clinic on March 17, 2010. 

    2.  A Notice of Privacy Practices (HIPAA) form.  Please read, sign and return the signature page with the consent form on March 17, 2010 at the clinic.

    3.  A Vaccine Information Sheet (VIS) on Live Attenuated Influenza Vaccine (LAIV) and Inactivated Injectable (shot).

    4.  A Immunization Registry notice to parents.
                    
                                                    Vaccination Clinic Date

Evans Ranch Elementary Wednesday March 17, 2010 from 3:00pm to 7:00 pm.

•  You may be present at the time of your child's vaccination.
  
•   If, for medical reasons, your child cannot receive the FluMist, he/she may receive the shot.

If you have any questions about Pandemic H1N1 influenza vaccination or FluMist, we encourage you to: 

Call your doctor's office.

Access the following website:  http://www.cdc.gov/h1n1flu.

If, for medical reasons, your child cannot receive the FluMist vaccine through this program, information can be provided to you for other free flu shot clinics.

FluMist Vaccination Forms

FluMist Consent - English / Spanish

Notice of Privacy Practices and Acknowledgement/VIS/Immunization Registry - English / Spanish

Riverside County H1N1 Vaccination Parent Letter - English / Spanish