Required fields are marked with asterisks (*)

RSV Vaccine and Immunization orders

Long-term care and retirement home vaccine orders

Order and pick-up instructions

Napanee based orders

Napanee orders need to be submitted by noon on Wednesday to be ready for pick-up at the Napanee office the following week.
Napanee office pick-up available Monday 1:00 to 4:30 pm and Tuesday to Friday 8:30 am to 12:00 pm and 1:00pm to 4:30pm.

Kingston based orders

Orders will be ready 72 hours after the order is placed. Kingston office pick up available Monday to Friday 8:30am to 4:30pm.

You may place your order now. All orders will be processeed as soon as product is available.

Please note that in some instances it may take longer than 72 hours to be processed, due to the approval process.

Temperature logs

Attach temperature log with temperatures from previous four weeks or since last order date

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Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif

If needed, download the Vaccine Temperature Log to document your dates and temperatures.

Facility information

Name of facility

Main fridge code

Phone number (999-999-9999)

Extension

Email address (we will send you a copy of this order for your records)

Approximate number of patients in practice

Approximate number of staff

Approximate number of residents OVER 65 years of age

Approximate number of residents UNDER 65 years of age

Do you currently have any additional orders placed for vaccines or medications

Yes

If yes, please specify which vaccine you have ordered:

High-risk vaccine(s)

Influenza vaccine(s)

STI medications

Would you like all of your orders prepared together rather than individually?

Yes

Vaccine ordering

Infant RSV - Beyfortus

Eligibility - Infants born in 2024, up to 12 months of age OR Children up to 24 months of age who are at high-risk. Please visit Respiratory Syncytial Virus | ontario.ca for more information about the infant and high-risk children RSV prevention program.

Beyfortus immunization is expected to arrive in Mid October, 2024

Orders may be placed now and will be processed as product becomes available.

Please report all Beyfortus immunizations to KFL&A Public Health.

Infant RSV - Beyfortus (50mg) (children weighing less than 5kg)

Yes

Infant RSV - Beyfortus (100mg) (children weighing greater or equal to 5kg)

Yes

RSV - Respiratory Syncytial Virus Stabilized Prefusion F Subunit (Abrysvo) - Older Adult

RSV - Respiratory Syncytial Virus Stabilized Prefusion F Subunit - Abrysvo - Older Adult

Yes

RSV - Respiratory Syncytial Virus Stabilized Prefusion F Subunit - Abrysvo - Pregnancy

Eligibility: Residents who are 32 to 36 weeks pregnant who do not wish for their baby to recieve the Beyfortus immunization.

Please visit Respiratory Syncytial Virus | ontario.ca for more information about the RSV vaccine in pregnancy.

RSV - Respiratory Syncytial Virus Stabilized Prefusion F Subunit - Abysvo- Pregnancy

Yes

comments or further details

Delivery

As per the Vaccine Storage and Handling guidelines vaccine transport is only permitted in a hard-shell cooler, cooled to between 2 to 8 degrees and monitored with a digital maximum and minimum thermometer capable of measuring in 0.1 degree increments.

Requested delivery method (please select one)

Pickup (please bring hard-shell cooler with the capacity to hold your entire order, cooled to 2 to 8°C)

Delivered by courier, arranged by KFL&A Public Health

Pickup

Kingston (Monday to Friday 8:30 a.m. to 4:30 p.m.). Orders will be ready 72 hours after they are placed.

Napanee (Monday 1:00 to 4:30 p.m., Tuesday to Friday 8:30 a.m. to 12:00 p.m. and 1:00 to 4:30 p.m.) Napanee orders need to be submitted by WEDNESDAY at NOON to be ready for pick-up at the Napanee office the following week.

Account number (Cost of delivery will be charged to the account number. Orders couriered from the Kingston office.)

Please specify any office closures that would affect delivery

By checking this box, I acknowledge I have read, understand, and agree that the information provided in this form is correct.

Yes

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