Colorado Immunization Program Materials Order Form

calendar calendar
Please select the materials you wish to receive. The items can be ordered in any quantity you desire, however we ask that you order only what you need as these forms are updated and changed regularly.


Record Cards

UPDATE** Immunization Administration Card for Child or Teen - We are no longer printing and sending out this form. This form can now be downloaded and printed here:
Vaccine Administration Records for Children and Teens http://www.immunize.org/catg.d/p2022.pdf
 
 This form is used in a provider's office as a means of creating a permanent record of immunizations.


UPDATE** Immunization Administration Card Expanded for Adults - We are no longer printing and sending out this form. This form can now be download and printed here: Vaccine Administration Records for Adults http://www.immunize.org/catg.d/p2023.pdf

This form is used in a provider's office as a means of creating a permanent record of immunizations.  This form also contains space for travel related immunizations.


The Child Immunization Record Card - Yellow card stock, tri-fold to 3.5" x 5"
These cards are provided to parents as a permanent record of the child's immunization history.


Adult Immunization Record - Purple card stock, tri-fold to credit card size
This form is given to an adult patient as a record of immunizations.  It also includes at-risk/travel vaccinations.

Reminder Cards - Your practice "Notice of Privacy" must state that cards may be sent to use the following items

Folding Reminder Card - English - Purple card stock, folded to 5.5" x 4.5"
These cards are to be used to notify a parent of a specifically needed immunization via mail.


Folding Reminder Cards - Spanish - Yellow card stock, folded to 5.5" x 4.5"
These cards are to be used to notify a parent of a specifically needed immunization via mail.


Reminder Card -English - Pink card stock, 5.5" x 4.5"
These are post card sized reminders that only list a child's name and contact info for the practice


Reminder Card -Spanish - Peach card stock, 5.5" x 4.5"
These are post card sized reminders that only list a child's name and contact info for the practice

Colorado Immunization Information System (CIIS) materials

PROVIDER Notification Poster -
This poster is recommended to be displayed in all practices who utilize the CIIS system. 
This poster is no longer on back order. 
 


SCHOOL/CHILD CARE Notification Poster -
This poster is recommended to be displayed in all SCHOOLS OR CHILD CARES who utilize the CIIS system. 
This poster is no longer on back order.