Colorado Immunization Program Materials Order Form

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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

Immunization Administration Card for Child or Teen - White card stock, Folded to 7.5" x 5"
This form is used in a provider's office as a means of creating a permanent record of immunizations.
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Immunization Administration Card Expanded for Adults - White card stock, folded to 7.5"x5"
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.
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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.
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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.
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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.
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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.
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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
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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
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Colorado Immunization Information System (CIIS) materials

Notification Poster -
This poster is required to be displayed in all practices who utilize the CIIS system. 
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CIIS Brochure-
This brochure contains basic information aimed at immunization provider clinics.
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* Indicates Response Required