Suburban Cook County Licensed Daycare Centers Vaccination Campaign

For Daycare Centers with Nurse Consultants

To provide H1N1 vaccination at your Center, a Memorandum of Agreement (MOA) and requested information is required. Participating daycare centers will be responsible for organizing the dates and times in which the Nurse Consultant will administer the vaccine. To support this initiative, CCDPH will provide the vaccine, vaccination supplies, and training for the Nurse Consultant at no charge for each participating daycare center.To participate in this program please complete, sign and return the following 2 Memorandums of Agreement.

  • Daycare Center MOA (to be completed and signed by Daycare Center Owner): CCHHS Updated 11-19-09 (PDF 49 KB)
  • Nurse Consultant MOA (to be completed and signed by Nurse Consultant and Nurse Consultant’s Employer): CCHHS Updated 11-19-09 (PDF 39.9 KB)

For Daycare Centers without Nurse Consultants

If your Daycare Center does not have or employ a Nurse Consultant please complete, sign and return the follow Memorandum of Agreement.

  • Daycare Center MOA (to be completed and signed by Daycare Center Owner): CCHHS Updated 11-19-09 (PDF 50.4 KB)

Please FAX and MAIL the competed and signed Memorandums of Agreement to: 
Cook County Department of Public Health
1010 Lake Street, Suite 300
Oak Park, IL 60301
Re: Daycare Center MOA
Fax: (708) 492-2900 OR (708) 786-4001

For questions about CCDPH’s vaccination program at daycare centers, please contact Debbie Brooks at 708-786-4057. 

CCDPH Information to provide to parents:

 

  • Complete Parent Information Packet for daycare vaccination campaign in ENGLISH: CCDPH Updated 11/19/09 (PDF 158 KB)
  • Complete Parent Information Packet for daycare vaccination campaign in SPANISH: CCDPH Updated 11/20/09 (PDF 588 KB)
    The packet includes a letter indicating that consent is required for a child to be vaccinated, two H1N1 Vaccination Information Sheets, a H1N1 Vaccine Consent Form and Notice of Privacy Practices. Individual documents are provided below.
    • It is the responsibility of each school (per MOA) to copy and send the packet to parents. CCDPH recommends daycare provide this packet of information to parents as soon as they decide they will be participating as a vaccination center.
    • A consent form must be completely filled out and signed by the parent/legal guardian for the child to be vaccinated.

For questions about CCDPH’s vaccination campaign or for more information specific to your daycare, please call the Flu (H1N1) Hotline at 708-492-2828.

Individual Forms (included in packets provided here seperately):

CCDPH Letter to parents:

CCDPH Notice of Privacy Practices:

CCDPH H1N1 Vaccination Consent Forms:

CDC H1N1 Vaccine Information Sheets Live Vaccine:

CDC H1N1 Vaccine Information Sheets Inactived Vaccine:

How to make an H1N1 Vaccination Appointment

Flu Questions?

Call the Flu hotline:   708-492-2828   or                    Email CCDPH: beaware@ccdph.net

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Confirmed H1N1 Hospitalizations and Deaths

(As of 03/05/10 10:00 AM)

  New Total
Hospitalized Cases
 2
 596
Deaths 0
 17

 

Confirmed H1N1 Hospitalizations and Deaths by Age Groups

(As of 03/05/10 10:00 AM)

Age Group (years) Hosp. Cases
 Deaths
0-4 97 1
5-24 174 4
25-49 176 6
50-64 108 3
65 and older 41 3
Unknown 0 0
TOTAL 596 17