Influenza Immunization Consent Form
Consentimiento para la Vacuna de Gripe/Influenza (página 2)
WALK-IN FLU CLINIC
SATURDAY, JANUARY 12, 2013
10 AM - 2 PM
Tillamook County Health Department
801 Pacific Ave, Tillamook
In light of the increasing number of cases
of influenza across the country and the increases we are beginning to see in
Tillamook County, and throughout the state, Tillamook County Health Department
will be holding a clinic for influenza vaccinations this coming Saturday,
January 12, 2013 from 10 AM – 2 PM. We strongly encourage all ages to receive
this vaccine due to the significant health risks from influenza, including
death, with this current influenza activity. There are adequate supplies of
influenza vaccination available.
There has been a spike of cases locally in recent weeks and of the cases that
have tested positive for the current strain, none are known to have received the
influenza vaccine.
The Immunization Clinic will be held Saturday, January 12, 2013 from 10 AM – 2
PM at the Tillamook County Health Department central clinic, 801 Pacific Ave. in
Tillamook, OR. Vaccinations will be given on a walk-in basis. There is not
available staff to answer phones and schedule appointments at this special
clinic. Be sure to bring insurance information if you have it.
PLEASE BRING YOUR INSURANCE CARD!
For Flu vaccine, we are able to bill Medicare, Oregon Health Plan, ODS, Providence Health Plan, and Regence Blue Cross (including federal employees and out-of-state Blue Cross). For Pneumonia vaccine, we only bill Medicare or Oregon Health Plan.
Flu Pool Vaccine is available for those who are uninsured/underinsured with a $15 administration fee. No one will be turned away for inability to pay.
Low cost Tdap vaccine is available - must meet eligibility requirements. Medicare DOES NOT pay for Tdap (unless due to an open wound injury)
$25 for Flu
$55 for Pneumovax
$65.25 for Tdap (includes pertussis or "whooping cough" vaccine)
¡POR FAVOR TRAIGA SU TARJETA DE SEGURO MÉDICO!
Para la vacuna de Flu, nosotros mandamos
el cuenta a Medicare, Oregon Health Plan, ODS, Providence Health Plan, y Regence Blue Cross of
Oregon SOLAMENTE (esto incluye empleados federales y fuera de otros
estados). Para la vacuna de Neumonía, solamente Medicare y Oregon Health
Plan.
La vacuna para las personas que no tienen aseguranza es gratis, pero tienen
que pagar $15 de la administración. A nadie se le niega la vacuna si no
puede pagar.
La vacuna de Tdap esta disponible de costo bajo - deben cumplir con los requisitos de elegibilidad. Medicare NO PAGA por la vacuna de Tdap (menos que sea debido por una lesión abierta o una herida.)
Precio de la vacuna del Flu: $25
Precio de la vacuna
de Neumonía: $55
$65.25 para Tdap (incluye la vacuna de la tos ferina)
This page last updated on 01/15/2013 03:50 PM