TRIM Ref: 15/14860
Catch-up Vaccination Schedule Form
Please note: catch-up schedules may take up to 14 working days to complete
Practice name _______________________________________________ Date __________________________
Staff requesting _____________________________________________________________________________
Phone number _________________________ Fax number __________________________________________
Practice email _______________________________________________________________________
Patient name _______________________________________________________________________________
Date of birth _________________________ Country of birth _________________________________________
Current school year (if applicable) ____________________________
Please complete the patient’s vaccination history in the table below. Then attempt to calculate the catch-up schedule
on the second page and forward both pages to the Public Health Unit to confirm. Both of these tables must be
completed for the catch-up to be considered. Photocopies of vaccination records will not be accepted.
The early childhood immunisation records of children are held on the Australian Childhood Immunisation Register.
You can check the child’s immunisation history by:
 Calling the Immunisation Register on 1800 653 809 or
 Online using the Identify Child and Record Encounter function through the ACIR secure area within HPOS
(Health Professional Online Services) humanservices.gov.au/hpos
Past Vaccination History (validated by ACIR/Overseas Encounter Form)
Date
Vaccine
Dose
Public Health Unit
Barber Ave, Kingswood NSW 2747
PO Box 63, Penrith NSW 2751
Tel (02) 4734 2022
Fax: (02) 4734 3444
TRIM Ref: 15/14860
Vaccination Catch-up Schedule as proposed by General Practice
Date
Vaccine
Dose
All vaccination catch-up schedules should be planned in accordance with the current Australian Immunisation
Handbook. Please refer to the catch-up section of the handbook (section 2.1.5).
If you have any further questions regarding this catch-up schedule or require general immunisation information, please
contact the Public Health Unit on 4734 2022.
Yours sincerely,
Dr Bradley Forssman
Director, Public Health
Public Health Unit
Barber Ave, Kingswood NSW 2747
PO Box 63, Penrith NSW 2751
Tel (02) 4734 2022
Fax: (02) 4734 3444