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Private Provider Materials Ordering Public Health Department Provider Materials Ordering







Statewide Statistics
School/Child Care
Hepatitis
Vaccines For Children






PRIVATE PROVIDER RESOURCE ORDER FORM

Name:
Organization:
Address:
City:

Date:
Phone:
Fax:
State:   Zip:

Please order the number of packages needed: English Spanish
Record Cards Adult Record Card (50)  
Pink USIR (250)  
Yellow Personal Record (50)  
Schedule Cards Adolescent (100)
Adult (100)
Childhood (100)
Childhood 8.5" x 11" (50)
Other Materials Plastic Sleeves (100)  
"Next Due" Stickers (250 per pad)  

Immunization Guide Book
(Redbook) 2007

Out of Stock  
School Rule Guide Book for Providers 2007 Out of Stock  
PPV Stickers (500 per roll)   
Vaccinate Before You Graduate Bookmark
Got Vaxed Bookmark  
Exemption Forms Medical  
Posters
Adult Schedule Poster 11" x 17"
Got Vaxed Poster Question Mark 14" x 20"  
Got Vaxed Poster Teenagers 14" x 20"  
Get the Flu Vaccine 11" x 17"
Preteen Doctor Visit 12" x 20" NEW
VIS Camera Ready Set
Brochures A Guide for Health Care Providers  
About Hepatitis A (50)
About Hepatitis B (50)
Got Vaxed Adolescent Brochure (100)  
Older Adults Need Shots (100)
Planning a Trip (100)  
Preteen Doctor Visit (100) NEW
Protect Yourself Adult (100)
Questions & Answers (25)
Vaccinate Before You Graduate (100)
Vaccine Safety (50)
Get the Flu Vaccine (50)
Tearpads & Notepads Got Vaxed Notepad 3" x 3"     
Resources for Immunizations Tearpad (50)  
Vaccine Administration Record Tearpad (50)  
VFC Information Tearpad (50)
Limited Materials Fever Scans (Limit 100)  
Rocking Horse Magnets (Limit 100)  
Contact Lisa Young with any questions (801) 538-9101 or email

Include quantities that will be sufficient for a three month period.

PLEASE ALLOW 2-3 WEEKS FOR DELIVERY

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