Delivery enquiry Tel: (03) 8588 1042 / Forward orders to Onelink:
Email: (order receipt issued) or
Fax: (03) 8588 1032
Allow a minimum of 3 business days (5 days during ‘flu’ season) for process and delivery of your vaccine order
Clinic name: / Account No.: / or / LGA / Centre name: / Account No.:Delivery address (not Post Office box): / Date:
Tel:
Fax:
Email: / Order number (optional):
In order to receive government funded vaccines, I agree:
1.To follow theFree vaccine Victoria – criteria for eligibility at
2. On receipt of the vaccine delivery, immediately check the TagAlert®temperature indicator.If the LCD is not displaying the ‘OK’ icon, immediately notify Onelinkas above
3. To comply with the vaccine cold chain storage requirements of 2ºC –8ºC contained in the National Vaccine Storage Guideline, Strive for 5.
Signature of
authorised person: / Print
name:
Government funded vaccine schedule
Store a maximum of one month’s stock
Number of doses in stock must be completed for orders to be processed / Vaccine brand® / Number of doses in stock / Number of doses required / 10-dose pack preferred
Birth / H-B-Vax II Paediatric / □
2 months (from 6 weeks), 4 and 6 months of age / Infanrix hexa / □
RotaTeq / □
Prevenar 13 / □
12 months of age / MMR II / Priorix / □
Menitorix / □
18 months of age / Priorix Tetra / ProQuad / □
4 years (from 3.5 years) of age
( Dose 2 of Priorix or MMR II due at this age until December 2015) / Infanrix IPV / □
6 months of age and over with a risk factor
6 to 59 months and 15 years of age and over for Aboriginal and Torres Strait Islander people
All pregnant women during any stage of pregnancy
65 years of age and older
**bioCSL’s Fluvax® is not licensed for use in children <5 years of age and not
recommended <10 years of age. / Fluarix
**Fluvax / Vaxigrip / A pre-allocation will be delivered to GP clinics and Community Health Centres annually in March / □
Children 6 months of age to <3 years of age, eligibility as above / Vaxigrip Junior
65 years of age, Aboriginal or Torres Strait Islander people at 50 years of age,
4-5 years of age with a risk factor / Pneumovax 23 / □
50–59 years of age (NOT for tetanus prone wounds – use Dr’s bag) / ADT Booster
Human Tuberculin / Tubersol
1ml vial = Approximately 10 tests
Year 7 students or 12-13 years old
(Mop-up Gardasil for boys 14-15 years old in 2015) / Varilrix / Varivax / □
Gardasil / □
Year 7, 8, 9 and 10 Secondary School students or 12-16 years of age
2015 only / Boostrix / □
Parent’s whooping cough vaccine program / Boostrix(PBOO) / □
Woman planning pregnancy and post-partum with low or negative rubella antibody / Priorix (HPRIO) / □
June 2015