Routine Vaccines and Vaccine Storage and Handling Resources Internal Form Search Submit Search Print this Page Home » For Professionals » Vaccine Ordering & Guidance » Orders and Returns – Vaccines » Routine Vaccines and Vaccine Storage and Handling Resources Internal Form This form is for Health Unit staff. Holding Point Number - see yellow sticker on vaccine fridge(Required)LGL_BR_00011 - AlmonteLGL_BR_00004 - BrockvilleLGL_BR_00009 - KemptvilleLGL_BR_00012 - GananoqueLGL_BR_00007 - Smiths FallsLGL_BR_00131 - Schools - NorthLGL_BR_00005 - Schools SouthRequisition Date(Required) Month Day Year Health Unit Office Pick Up Location(Required) Brockville Gananoque Kemptville Smiths Falls Almonte Vaccine ContactVaccine Contact Name(Required) First Name Last Name Phone(Required)ExtensionEmail(Required) CommentsPlease indicate which you will be ordering: Routine Vaccines and/or Vaccine Storage and Handling ResourcesWhat will you be ordering?(Required) Routine Vaccines Vaccine Storage and Handling Resources Payable Vaccines School Clinic Vaccines New provider Cooler pack (cooler, water blankets, ice packs, thermometer) Which Routine Vaccine(s) would you like to order?(Required) Rotavirus Vaccine (Rotarix) Eligible age ≥ 6 weeks – 24 weeks old Prevnar 15 (Pneu-C-15) Eligible age 6 weeks – 4 years DTap-IPV-Hib Vaccine (Pediacel) Eligible age ≥ 6 weeks – 6 years Men C-C (Menjugate/NeisVac) Eligible age ≥ 1 year MMR Vaccine (MMRII/Priorix) Eligible age ≥ 1 year MMR-V Vaccine (Pro-Quad/Prioix-Tetra) Eligible age 4 – 12 years Varicella Vaccine (Varilrix/Varivax) Eligible age Born after 2000 and ≥ 1 year of age Tdap Vaccine (Adacel/Boostrix) Eligible age ≥ 4 years + pregnancy Tdap-IPV Vaccine (Adacel-IPV/Boostrix-Polio) Eligible age ≥ 4 years Td Adsorbed Vaccine Eligible age ≥ 7 years Prevnar20 Vaccine (Pneu-C-20) Eligible age ≥ 65 years Shingles (Shingrix Vaccine) 65-70 years) Polio (IPV Imovax) eligible age ≥ 6 weeks of age Which Vaccine Storage and Handling Resources would you like to order?(Required) Do Not Unplug sticker - English How to Monitor Refrigerator Temperature sticker - English Immunization Cards Protect Your Vaccines - Protect Your Patients poster - English Stop sticker - English Vaccine Refrigerator Maintenance Log Book - English Vaccine Temperature Log Book - English Which Payable Vaccines would you like to order?(Required) HPV 9 Which School Clinics Vaccines would you like to order?(Required) Men C - ACYW135 Hep B Hep B pediatric HPV 9 Epinephrine Routine VaccinesRotavirus Vaccine Doses Currently in our Vaccine Fridge(Required)Catalogue number 6571-4233-0 1 dose per packageRotavirus Vaccine Doses Required(Required)Catalogue number 6571-4233-0 1 dose per packagePrevnar 15 Vaccine (Pneu-C-15) Doses Currently in our Vaccine Fridge(Required)Prevnar 15 Vaccine (Pneu-C-15) Doses Required(Required)DTap-IPV-Hib Vaccine (Pediacel) Doses Currently in the Fridge(Required)DTap-IPV-Hib Vaccine (Pediacel) Doses Required(Required)Men C-C (Menjugate/NeisVac) Doses Currently in our Vaccine Fridge(Required)Catalogue number 6571-3344-3 10 doses per packageMen C-C (Menjugate/NeisVac) Doses Required(Required)Catalogue number 6571-3344-3 10 doses per packageMMR Vaccine (MMRII/Priorix) Doses Currently in our Vaccine Fridge(Required)Catalogue number 6571-3230-0 10 doses per packageMMR Vaccine (MMRII/Priorix) Doses Required(Required)Catalogue number 6571-3230-0 10 doses per packageMMR-V Vaccine (Pro-Quad/Prioix-Tetra) Doses Currently in our Vaccine Fridge(Required)Catalogue number 6571-3604-0 10 doses per packageMMR-V Vaccine (Pro-Quad/Prioix-Tetra) Doses Required(Required)Catalogue number 6571-3604-0 10 doses per packageVaricella Vaccine (Varilrix/Varivax) Doses Currently in our Vaccine Fridge(Required)Catalogue number 6571-3305-0 10 doses per packageVaricella Vaccine (Varilrix/Varivax) Doses Required(Required)Catalogue number 6571-3305-0 10 doses per packageTdap Vaccine (Adacel/Boostrix) Doses Currently in our Vaccine Fridge(Required)Catalogue number 6571-2203-0 5 doses per packageTdap Vaccine (Adacel/Boostrix) Doses Required(Required)Catalogue number 6571-2203-0 5 doses per packageTdap-IPV Vaccine (Adacel-IPV/Boostrix-Polio) Doses Currently in our Vaccine Fridge(Required)Catalogue number 6571-2013-1 10 doses per packageTdap-IPV Vaccine (Adacel-IPV/Boostrix-Polio) Doses Required(Required)Catalogue number 6571-2013-1 10 doses per packageTd Adsorbed Vaccine Doses Currently in our Vaccine Fridge(Required)Td Adsorbed Vaccine Doses Required(Required)Prevnar20 Vaccine (Pneu-C-20) Doses Currently in our Vaccine Fridge(Required)Prevnar20 Vaccine (Pneu-C-20) Doses Required(Required)Shingles (Shingrix Vaccine) Doses Currently in our Vaccine Fridge(Required)Catalogue number 6571-2020-1 1 or 10 doses per packageShingles (Shingrix Vaccine) Doses Required(Required)Catalogue number 6571-2020-1 1 or 10 doses per packagePolio (IPV Imovax) Vaccine Doses Currently in our Vaccine Fridge(Required)Polio (IPV Imovax) Vaccine Doses Required(Required)Vaccine Storage and Handling ResourcesDo Not Unplug sticker – English – Quantity Required(Required)Catalogue number 7540-1954-0How to Monitor Refrigerator Temperature sticker – English – Quantity Required(Required)Catalogue number 7540-1938-0Immunization Cards (package of 25) – Quantity Required(Required)Package of 25Protect Your Vaccines – Protect Your Patients poster – English - Quantity Required(Required)Catalogue number 7540-1922-0Stop sticker – English – Quantity Required(Required)Catalogue number 7540-1955-0Vaccine Refrigerator Maintenance Log Book – English – Quantity Required(Required)Vaccine Temperature Log Book – English – Quantity Required(Required)Catalogue number 7610-1908-0Payable VaccinesHPV 9 Vaccine Doses Currently in our Vaccine Fridge(Required)HPV 9 Vaccine Doses Required(Required)School Clinic VaccinesMen C – ACYW135 Vaccine Doses Currently in our Vaccine Fridge(Required)Men C – ACYW135 Vaccine Doses Required(Required)Hep B Vaccine Doses Currently in our Vaccine Fridge(Required)Hep B Vaccine Doses Required(Required)Hep B Pediatric Vaccine Doses Currently in our Vaccine Fridge(Required)Hep B Pediatric Vaccine Doses Required(Required)HPV 9 Vaccine Doses Currently in our Vaccine Fridge(Required)HPV 9 Vaccine Doses Required(Required)Epinephrine Vaccine Doses Currently in our Vaccine Fridge(Required)Epinephrine Vaccine Doses Required(Required)