5.3 School-Based Program

PHN To Do List for School Based Mass Clinics

General Information for School Based Program

i. Eligibility Criteria

ii. School Based Resources

• School Immunization Program
  • Provincial School Based Immunization Quick Reference Guide (July 2024)
• School Immunization Consent Form, Grade 6 or Grade 8/9
  • English – Letter I English – Legal
  • French – Letter I French – Legal
• Grade 6 and Grade 8 Letter to Parents 2024-2025  English | French
• Record of Immunization Form
• Record of Immunization Form *For Students that required 3 doses of HPV/HBV
• Child Requires Additional Dose Bilingual Letter
• Child not Immunized Letter English | French (Updated June 2024)
• Child/Adolescent (General) Immunization Consent Form English | French (Updated June 2024)
• Immunization reminder letter English | French
• Kindergarten letter English | French
• Home School Letter English | French
• Dear Parent Grade 6-8 Bilingual Letter

iii. Training

• Manitoba Health School Based Immunization Program (Updated August 8, 2024)

Grade 6 and 8 Program – Human Papilloma Vaccine (HPV),  Hepatitis B Vaccine (HBV) & Meningococcal Quadrivalent Vaccine (Men-C-ACYW-135)

i. Resources

• Grade 6 School Immunization Program Fact Sheet English / French

ii. Human Papilloma Virus

• Fact Sheet  English | French
• Product Monograph

iii. Hepatitis B Vaccine

• Fact Sheet  English | French
• Product Monograph

iv.  Meningococcal Quadrivalent Vaccine (Men-C-ACYW-135)

• Fact Sheet  English | French
• Product Monograph:
  • Menactra
  • Nimenrix

Grade 8 Program – Tetanus, Diphtheria acellular pertussis (Tdap) & Tdap/ IPV (Polio);

i. Resources

• Grade 8 / 9 School Immunization Program Fact Sheet English | French

ii. Tetanus, Diphtheria acellular pertussis (Tdap) & Tdap/ IPV (Polio)

• Fact Sheet Tdap English | French
• Fact Sheet Tdap-IPV English | French
• Product Monograph:
  • Boostrix
  • Boostrix-Polio

Back to Section 05 – Population Public Health Program Specific Information

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