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Vaccine Consent Forms
Before completing this form, please contact an immunization nurse at (616) 396-5266.
Request for Records
Contact your health care provider. If you received immunizations at the Ottawa County Department
of Public Health, complete the records request form, and fax to one of our offices. If you received immunizations in Michigan, records may be in
the Michigan Care Improvement Registry (MCIR). Contact your health care provider or our
department to request a search. Your legal name and date of birth are required for the search.
Other tips for locating your immunization records.
Vaccination requirements for school/ preschool/childcare entry are implemented to maintain high vaccination coverage and protect children from vaccine-preventable diseases. Before a child can attend seventh grade, kindergarten, preschool, childcare or enroll in a new school district in Michigan; parents or guardians are required to produce documentation that confirms their child has either received the school/ preschool/childcare - required immunizations, has received at least one dose of each of the required immunizations and is in a waiting period to receive subsequent doses to be administered at the recommended intervals, or has a valid waiver.
Find State Summary Reports by school buildings or preschool/childcare sites that measure compliance with immunization requirements among children enrolled in seventh grade, kindergarten, preschool, childcare and new entrants to the school district.
Many people think immunizations are only for children, but vaccines are important for people of all ages. Adults, depending on their age and current medical condition, should receive the following: Tdap/Td, HPV, influenza, pneumonia and shingles immunizations.
Recommended Vaccine Schedules
- Immunization Schedule
- Vaccine Recommendations for Health Care Personnel
- Vaccine and Travel Clinic Charges
- Vaccine Quiz
Immunizations do not have to be expensive. The Ottawa County Department of Public Health participates
with the Vaccines for Children Program which provides free vaccines to children who have no health
insurance, are on Medicaid or have insurance that does not cover any part of the cost of vaccines. An
administration fee is charged with each vaccine given. The fee is determined on a sliding scale based
on household income and number of persons in the family. If you are concerned about the cost of
immunizations for your child, please call 396-5266 and ask to speak to an immunization nurse.
Many health insurance plans cover routine immunizations. Please check with your insurer.
If your insurance covers the cost of immunizations, it is best to go to your physician's office to
Click here to view the fees for travel and adult immunizations.
Vaccines are the single most powerful, cost-effective public health intervention ever developed. They have reduced, and in some cases, eliminated debilitating and life threatening diseases. The following websites provide resources on vaccine safety:
Did you know certain vaccines are recommended for adults? Take this quick quiz to find out which vaccines you may need. Please call the Ottawa County Department of Public Health at (616) 396-5266 if you are interested in one or more of these vaccines:
- Tdap/Td Vaccine (Tetanus, Diphtheria & Pertussis) – Tdap is recommended for all adults who
have not received a dose of Tdap vaccine with high priority for those who have close contact with an
infant younger than 12 months of age and health care workers. Tdap should be given to pregnant women
during each pregnancy (preferred during 27-36 weeks' gestation), regardless of the number of years since
last Td or Tdap.
- MMR Vaccine (Measles, Mumps & Rubella) - recommended for those born on or after 1/1/57 with no documented history of receiving two doses of MMR vaccine at least one month apart .
- Hepatitis A and Hepatitis B Vaccines - recommended for those in certain high risk groups. Call for more information.
- Varicella Vaccine (Chickenpox) - recommended for those born in or after 1980 who have never had chickenpox.
- Influenza vaccine is recommended for everyone, every year.
- Pneumococcal conjugate vaccine (PCV13) and Pneumococcal polysaccharide vaccine (PPSV23) - recommended for all adults 65 years and older. PCV13 should be given first followed one year later by PPSV23. Adults 19-65 years of age with diabetes, heart or lung disease or certain other chronic conditions also need these vaccines. Call for more information.
- Zoster (Shingles) Vaccine – It is recommended that healthy adults 50 years and older get two doses of the shingles vaccine called Shingrix (recombinant zoster vaccine). Call 616-396-5266 for more information.
Annually, 700 million travelers cross international borders and as many as 70% of them become ill. The Ottawa
County Department of Public Health believes staying healthy while traveling involves more than "getting
shots", and the Department of Public Health's "Travel Clinic" can help ensure your best
chances for good health during your travels.
Our Travel Clinic has appointments in each of our Department of Public Health offices. During a travel clinic visit, the staff will review your trip itinerary and your medical history. You will receive the most current information specific to your trip from professional travel authorities such as Centers for Disease Control and Prevention, the World Health Organization, and Shoreland, Inc. The clinic staff will recommend and administer travel vaccines indicated for you, based on your medical history and the anticipated risk of exposure during your travels. You will also be provided with information and counseled on common health hazards which might be encountered on your trip, such as insect/water-borne illnesses and other non-vaccine preventable infections, recent infectious outbreaks in the area, and health care standards and health care availability at your destination. In addition, you will receive up-to-date information on safety and security alerts for your destination as well as general advice on how to remain healthy while traveling. All information will be provided in a convenient packet to take with you on your trip.
The Travel Clinic office visit fee is $80. The travel vaccinations are in addition to this fee. Payment is due at time of service. Cash, check, MasterCard, VISA, Discover Card and American Express are accepted. Please note: travel vaccines are not generally covered by insurance. However, a detailed statement will be provided to you at the time of payment which you can forward to your insurance company in the event this expense is covered.
Please call (616) 396-5266 to make a travel clinic appointment. Ideally, you should call 4-6 weeks prior to your departure date.
International Adoption Immunization & Travel Recommendations
Adoption is an exciting, rewarding and busy time for all involved. International adoption can present some additional challenges. The Ottawa County Department of Public Health's Travel Clinic offers advice on recommended and/or required immunizations for traveling to the country of your child, advice on keeping you and your family healthy while traveling and handouts on health recommendations before and after international adoption. The Centers for Disease Control and Prevention also offers more information about immunizations and international adoption.
- Allied Vaccine Group
This site is comprised of links to 7 websites dedicated to presenting valid scientific information about the sometimes-confusing subject of vaccines.
- Autism Science Foundation
- CDC - Reasons to Follow Recommended Immunization Schedule
- CDC - Vaccines Do Not Cause Autism
- Childhood Immunization
Created by the American Academy of Pediatrics, this site contains immunization information for professionals and the general public.
- Evidence Shows Vaccines Unrelated to Autism
- Families Fighting Flu
- Handouts for Patients & Staff
- History of Vaccines
- Immunization Action Coaltion's Parent
- Immunization Action Coaltion's handout: MMR vaccine does not cause autism. Examine the evidence!
- Michigan County Immunization Report Cards
Information for parents about infectious diseases and how to prevent them
- ImmYounity (sponsored by Sanofi Pasteur)
- Vaccinate Your Family
- Vaccines - Calling the Shots Nova Video - Examine the science behind vaccinations, the return of preventable diseases, and the risks of opting out.
- Vaccine Information.org
For parents and people of all ages, this webpage provides timely, accurate and proven information about vaccines and the diseases they prevent.
- Vaccine Information for Parents
Education Center at Children’s Hospital of Philadelphia
The goal of the Vaccine Education Center is to provide concise, accurate information on all aspects of vaccines and immunization.
- Vaccines: Talking About Vaccines with Dr. Paul Offit
- Vaccines: Your best shot at good health
- Voices of Meningitis
- Voices for Vaccines - parents speaking up for immunization
2020 Private Provider Meeting Dates
- Wednesday, February 26, 11:30am-1pm
- Wednesday, May 20, 11:30am-1pm
- Wednesday, September 16, 11:30am-1pm
- Wednesday, December 9, 11:30am-1pm
Please call 616-396-5266 for more information.
Vaccines for Children (VFC) Program
The VFC Program provides federally purchased vaccines for children 18 years of age and younger who are Medicaid eligible, uninsured, American Indian or Alaskan Native, or are under-insured. There are many benefits for both providers and their patients to participate in this program which include keeping children in their medical home and a link to a network of experts, can provide up-to-date information on immunizations. The Vaccines for Children Program is available to Ottawa County physician offices for children birth through 18 years of age. If you would like more information about the VFC Program, please contact the Immunization Supervisor at (616) 396-5266.
VFC Program information: www.michigan.gov/vfc
Instructions for the Use of Vaccine Information Statements - Required Use
1. Provide Vaccine Information Statement (VIS) when vaccination is given.
As required under the National Childhood Vaccine Injury Act (42 U.S.C. §300aa-26), all health care providers in the United States who administer, to any child or adult, diphtheria, tetanus, pertussis, measles, mumps, rubella, polio, hepatitis A, hepatitis B, Haemophilus influenzae type b (Hib), influenza, pneumococcal conjugate, meningococcal, rotavirus, human papillomavirus (HPV), or varicella (chickenpox) vaccines shall, prior to administration of each dose of the vaccine, provide a copy to keep of the relevant current edition vaccine information materials that have been produced by the Centers for Disease Control and Prevention (CDC):
- to the parent or legal representative* of any child to whom the provider intends to administer such vaccine, and
- to any adult to whom the provider intends to administer such vaccine. (In the case of an incompetent adult, relevant VISs shall be provided to the individual's legal representative.* If the incompetent adult is living in a long-term care facility, all relevant VISs may be provided at the time of admission, or at the time of consent if later than admission, rather than prior to each immunization.)
If there is not a single VIS for a combination vaccine, use the VISs for all component vaccines. The materials shall be supplemented with visual presentations or oral explanations, as appropriate.
2. Record information for each VIS provided.
Health care providers shall make a notation in each patient's permanent medical record at the time vaccine information materials are provided, indicating:
(1) the edition date of the Vaccine Information Statement distributed, and
(2) the date the VIS was provided.
This record keeping requirement supplements the requirement of 42 U.S.C. §300aa-25 that all health care providers administering these vaccines must record in the patient's permanent medical record (or in a permanent office log):
(3) the name, address and title of the individual who administers the vaccine,
(4) the date of administration, and
(5) the vaccine manufacturer and lot number of the vaccine used.
Availability of Copies
In Michigan: health care providers should use the Michigan versions of the VIS. Copies are available at your local Department of Public Health or at Michigan Department of Health and Human Services. Copies are available in English and in other languages. VIS Sheet Order Form
Immunization Education for Provider Offices
The Ottawa County Department of Public Health in conjunction with the Michigan Department of Health and Human Services (MDHHS) can provide educational in-services to provider offices to increase staffs' knowledge of immunizations. These in-services are conducted by MDHHS approved Immunization Nurse Educators. They are provided free of charge and participants can receive continuing education credits. Each in-service varies in presentation length, but many can be provided over a 75 minute lunch hour. The current available modules are:
- Infant Child Update - 1.25 hours
- Adolescent Update - 1.25 hours
- Adult Update - 1.25 hours
- Vaccines Across the Lifespan - 2.25 hours
- Vaccine Management: Storage and Handling - 1 hour
- Vaccine Administration and Pain Management - 1 hour
- Vaccines for Children Program - 1.5 hours
- Influenza Update (available in the fall/early winter) - 1 hour
- Vaccinating Women Across their Lifespan OB/GYN Update - 1.25 hours
2020 Immunization In-Service Dates
- Vaccine Administration and Pain Management
- Vaccines Across the Lifespan
- Vaccines Across the Lifespan
In-person educational sessions have been temporarily suspended. Please watch your email for any virtual sessions that may be offered in the future.
To pre-register for one of these sessions, please contact Robin Schurman, BSN, RN at 616-393-5750 or email@example.com
Reporting Vaccine Preventable Diseases
Please remember that all vaccine preventable diseases need to be reported to your local Department of Public Health. Visit our Disease Reporting for more information.
Great Immunization Resources for Your Office
The Michigan Department of Health and Human Services Immunization website is a great place to download current copies of the Vaccine Information Statements (VIS) with Michigan Care Improvement Registry (MCIR) language and for foreign language VISs. This site includes information on:
- Current vaccine recommendations, schedules
- Vaccines for travel, influenza and more
- MCIR site Region 2
The Alliance in Michigan Provider Toolkit is an excellent resource for the most up to date immunization related information. The toolkit has six sections of information:
- Childhood 0-6 years
- Adolescent 7-18 years
- Adult 19 years and older
- Vaccine Safety
- Vaccine Storage and Handling; Other Resources
The Centers for Disease Control's National Immunization Program has information for providers and community members such as:
- Current vaccine recommendations
- Frequently asked questions
- Vaccines for Children program
- Immunization recommendations for healthcare workers
The Immunization Action Coalition offers a variety of helpful tools, handouts, and informational pieces for health care providers and their patients.