H1N1 FLU SHOT CLINIC -GMA Patients Only

Name

Date of Birth

Thank you for your understanding and patience regarding respecting the priority of this vaccine to only high risk patients.

Because of our limited supply, we are asking that only high risk patients request the vaccine.   Once we receive your request, your physician will decide if you are in this priority category and will contact you.  

-pregnant women

-people who live with or provide care for infants younger than 6 months (e.g., parents, siblings, and day care providers)

-health care and emergency medical services personnel

-people 6 months through 24 years of age (especially those with higher risk for influenza-related complications like children                             younger than 5 years and those who have high risk medical conditions)                                                                                 -people 25 years through 64 years of age who have certain medical conditions that put them at higher risk for influenza-related                         complications.

State your reason for high risk.

Once the demand for vaccine for the target groups has been met at the local level, ACIP recommends that programs and providers begin vaccinating everyone from the ages of 25 through 64 years. Current studies indicate that the risk for infection among persons 65 and older is less than the risk for younger age groups. However, once vaccine demand among younger age groups has been met, ACIP recommends that programs and providers should offer vaccination to people 65 or older.