Public Health Unit APPROVED APPLICANT REQUEST FOR SCHOOL VACCINATION RECORDS

Please note: The Public Health Unit has access to the following school vaccination records for schools within Shoalhaven Local Health District and South Eastern Sydney Local Health District

Completion of this written request is necessary to meet the requirements of the NSW Health records and Information Privacy Act and NSW Health Adolescent Vaccination program protocols.

All students were given a “Record of Vaccination” card when vaccinated at school. Check if you have this record card before sending your request.

The Public health Unit will endeavour to upload all school vaccination records into the Australian Immunisation Register

Please indicate what year it was when he/she was in Year7 ______

Vaccination records requested (tick records required) / Purpose for vaccination records (Please tick)

Meningococcal ☐ Study/work ☐ Diphtheria/Tetanus/Pertussis (dTpa/Boostrix) ☐ Own information ☐ Hepatitis B Program ☐ Centerlink ☐

Varicella (Chickenpox) Program ☐ Human Papillomavirus (HPV) Program ☐ Measles, Mumps, Rubella (MMR)

(From 2014 – 2015) ☐

The following details MUST be completed:

Student’s family name

Student’s given name

Student’s date of birth

Student’s Medicare Number

School/s attended from 2003 - Current (list for each year if changed)

Postal Address:

Parent/Applicant Contact Details Fax Number: Email Address: Phone/mobile number: (in case clarification is required)

Requested by: ______GP/Parent/Self (Please circle)

Signature: ______Date: ______

Note: The Public Health Unit has access to school vaccination records for schools within the Illawarra Shoalhaven Local Health District from 2003 Public Health Unit - Office Locked Mail Bag 9 WOLLONGONG NSW 2500 Tel (02) 4221 6700 Fax (02) 4221 6759

Public Health Unit

Our Schools include: South Eastern Sydney Schools covered 2009, 2010 & 11

Alesco Learning Centre Illawarra St John’s Bosco Albion Park High School Lucas Heights Community School Aspect School (Cedars Christian College) Menai High School Bomaderry High School Aquinas College Budawang SSP Boys Town Engadine High School Cedars Christian College Heathcote High School Corpus Christi Catholic High School Inaburra Southern Cross Baptist School Craig Davis College Sutherland Shire Christian School Edmund Rice College Elonera Montessori School Five Islands Secondary College Flametree Behavioural Centre Havenlee SSP Holy Spirit College Illawarra Christian School - Cordeaux Campus Illawarra Christian School - Tongarra Campus Illawarra Sports High School High School M.E.T. School Nowra Anglican College Nowra Christian School Oak Flats High School ParaMeadows SSP Park Rd. Unit (Attached to Shoalhaven High School) Peterborough SSP Shellharbour Anglican College Shoalhaven Anglican School Shoalhaven High School Smith Street Unit (Attached to Wollongong High School) Smith's Hill High School St John the Evangelist Catholic High School St Joseph's Catholic High School St Mary's Star of the Sea College TIGS - The Warrawong High School Warrawong Intensive English Centre (IEC) Wollongong Flexible Learning Centre Wollongong High School of the Performing Arts Woonona High School

Public Health Unit - Wollongong Office Locked Mail Bag 9 WOLLONGONG NSW 2500 Tel (02) 4221 6700 Fax (02) 4221 6759