Colorado Immunization Branch Materials Order Form

Order Date * +

Facility Name

Facility Type *

First Name *

Last Name *

Street Address or PO BOX number *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address

Immunization Record Cards

Child and Teen Immunization Record Card - Yellow card stock, quad fold to 2" x 3"
These cards are provided to parents as a permanent record of a child's immunization history.

Only clinics are allowed to distribute these Record Cards.

Child and Teen Immunization Record Card [#8] - Quantity requested:

Adult Immunization Record Card- Purple card stock, tri-fold to credit card size

This form is given to an adult patient as a record of immunizations.

Only clinics are allowed to distribute these Record Cards.

Adult Immunization Record Card [#10] - Quantity requested:

Lifetime Immunization Record Card- Green card stock, tri-fold to credit card size

This form is given to a patient as a record of immunizations.

Only clinics are allowed to distribute these Record Cards.

Lifetime Immunization Record Card [#45] - Quantity requested:

Immunization Record Card Protective Sleeve [#9] - Note: This protective sleeve is larger than the size of the record cards but still keeps them protected. While supplies last.
Quantity requested:

2024 Child and Adolescent Laminated Immunization Schedule

The 2024 U.S. Recommended Child and Adolescent Immunization Schedule to place in exam rooms. 8 panels that fold down to 8 1/2" X 11"

Child and Adolescent Immunization Schedule [#11] - Quantity requested (15 per clinic and 1 per school is the maximum order):

2024 Adult Laminated Immunization Schedule

The 2024 U.S. Recommended Adult Immunization Schedule to place in exam rooms. 6 panels that fold down to 8 1/2" X 11"

Adult Immunization Schedule [#12] - Quantity requested (10 per clinic and 1 per school is the maximum order):

2024 Childhood, Adolescent, Adult, Perinatal Hepatitis B, and Contraindications Palm Cards

The 2024 Immunization Palm Cards are laminated, hole-punched cards designed to be attached to badges and provide a quick reference for those involved in immunization delivery.The palm cards reflect the latest Advisory Committee on Immunization Practices (ACIP) recommendations.

Palm Cards can be ordered directly from Immunize Colorado's Online Store.

During Pandemic Stay Current With Vaccines Resources

Parent Postcard - 4" X 6" postcard - These postcards remind parents that it is important to immunize their children during the pandemic.

English Postcard [#13] - Quantity requested:

Spanish Postcard [#14]- Quantity requested:

For the original image of the Parent Postcard or to see it in other languages link to https://www.colorado.gov/pacific/cdphe/child-cares-schools-and-collegesuniversities-immunization-resources

Parent Flyer - 8 1/2" X 11" - This flyer hangs on any door or wall and reminds parents of the importance of vaccinating their children during the pandemic.

Parent Flyer - English [#15] - Quantity requested:

Parent Flyer - Spanish [#16] - Quantity requested:

For the original image of the Parent Flyer or to see it in other languages link to https://www.colorado.gov/pacific/cdphe/child-cares-schools-and-collegesuniversities-immunization-resources

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

Folding Child Reminder Card - English - White 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 Child Reminder Cards - English [#41] - Quantity requested:

Folding Child Reminder Cards - Spanish - White 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 Child Reminder Cards - Spanish [#42] - Quantity requested:

Folding Adult Reminder Cards - English - White card stock, folded to 5.5" x 4.5" These cards are to be used to notify a patient of a specifically needed immunization via mail.

Adult Reminder Card - Spanish [#50] - Quantity requested:

Folding Adult Reminder Cards - English - White card stock, folded to 5.5" x 4.5" These cards are to be used to notify a patient of a specifically needed immunization via mail.

Adult Reminder Card - Spanish [#51] - Quantity requested:

PROVIDER Notification Poster -
This poster is recommended to be displayed in all practices who use the CIIS system.

This poster has been updated to include more languages and will no longer be available for order. You may find and print the updated poster here: https://www.colorado.gov/pacific/cdphe/statutory-notice-patients-right-opt-out