REQUEST FORM
Influenza and PPSV Vaccination Pocket Guides
 
Dear Colleague,
The National Influenza Vaccine Summit will once again provide laminated influenza vaccination pocket guides free-of-charge to assist healthcare professionals in vaccinating patients against influenza. This is the ninth consecutive year that the Summit has produced and distributed such a pocket guide. The Summit is pleased to also be able to continue distribution of a similar pocket guide to aid in vaccination efforts with pneumococcal polysaccharide vaccine (PPSV).
The purpose of each of these pocket guides is to provide front-line healthcare personnel with information on:
•
indications and contraindications for the vaccines
•

information on targeted populations to be vaccinated
• details on how to administer the vaccines
• talking points for patients
The pocket guides are NOT intended to be distributed to patients. They are for the use of healthcare professionals only.
Each of these pocket guides is available at no cost to your agency or organization. We encourage you to distribute the pocket guides to your members or constituents along with your encouragement to use the pocket guides to avoid missed opportunities.
 
Diane C. Peterson
Immunization Action Coalition
On behalf of the National Influenza Vaccine Summit
 
Information About  the Pocket Guides
Influenza pocket guide
Influenza Pocket Guide
The influenza pocket guides are laminated for durability, printed in easy-to-spot orange and black, and sized to fit in a shirt or lab coat pocket (3-3/4" x 6-3/4").
View the influenza pocket guide [PDF]
 
PPSV pocket guide
PPSV Pocket Guide
The pneumococcal polysaccharide vaccine (PPSV) pocket guides are laminated for durability, printed in easy-to-spot lime green and black, and sized to fit in a shirt or lab coat pocket (3-3/4" x 6-3/4").
View the PPSV pocket guide [PDF]
 
 
Request Form
If you would like to order a bulk number of free pocket guides, please fill out the online form below.
We encourage you to fill out this form as soon as possible as quantities are limited. Pocket guides are projected to be shipped beginning in late August or early September and are available for distribution only within the U.S. and U.S. territories.
Items in red are required. You will be sent an email message containing a copy of the information you enter.
   
  Influenza Pocket Guides
 
  Quantity of influenza pocket guides:
(minimum 10)
 

If requesting influenza pocket guides, please write
a sentence or two about how you will use them.
We MUST have this information:
   
PPSV Pocket Guides
 
  Quantity of PPSV pocket guides:
(minimum 10)
 

If requesting PPSV pocket guides, please write
a sentence or two about how you will use them.
We MUST have this information:
   
Contact Information
  First Name:
  Last Name:
  Job Title:
  Email Address:
  Confirm Email Address:
  Organization:

  Address1:

  Address2:
  City:

  State:
  Zip:

  Phone:
     
  Shipping contact information (if different from above)
  Name:
  Email Address:
  Organization:
  Address1:

  Address2:
  City:

  State:
  Zip:

  Phone:
   


 
 
 
 
Internal use only