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STUDENT PEEHIP Flu Vaccine Program 2022

 PEEHIP Flu Vaccine Program for Students 

 

The Alabama Department of Public Health will offer the Flu Shot to students age Pre K-4 years through 12th grade that have PEEHIP Insurance (BC/BS insurance number that begins with EDU).  This school vaccination program is voluntary and parents must complete the attached permission form and return to the school nurse one week before the school clinic.   

 

Parent Reminders for filling out flu form:
1. Please use black ink only!
2. Please make sure all boxes are filled out correctly. 
3. Under patient information, please make sure to put the last four of the child who is receiving the vaccine's social. Not the parents. 
4. Please answer all of the yes/no questions. 
5. Please sign and date the form. The vaccine can not be administered without a signature. 
6. Forms must be original and turned in to the Alabama Department of Public Health Vaccination team by the school nurse on the day of the clinic. We can not accept emailed or faxed copies. Must have that original signature.   

 

 

ADPH Student Consent Flu Vaccine Form 2022

 

ADPH Flu Vaccine Information Sheet 2022