OHC VACCINATION CLINIC

Group 1

Clients Living in Licensed Care Facilities

• Identification with photo (Face sheet with photo from the residential facility is acceptable)

• Completely filled out and signed informed consent form (parents' or conservator's signature giving informed consent in behalf of the client is acceptable)

• Doctor’s Order (if client is unable to sign the informed consent or if no one is able to do so in behalf of the client, e.g., conservator or parent is not able to sign)

• Health Insurance Card/Information

• Note: Wear a short-sleeved shirt, if possible

Group 2

Caregivers, Staff, Family & Relatives

• Identification with photo

• Completely filled out and signed informed consent form

• Doctor’s Order (for those unable to give consent)

• Health Insurance Card/Information

• Note: Wear a short-sleeved shirt, if possible

Group 3

Clients Living with Family Members

• Identification with photo (For OHC clients, face sheet with photo from the facility is acceptable)

• Completely filled out and signed informed consent form (parents' or conservator's signature giving informed consent in behalf of the client is acceptable)

• Doctor’s Order (if client is unable to sign the informed consent or if no one is able to do so in behalf of the client, e.g., conservator or parent is not able to sign)

• Health Insurance Card/Information

• Note: Wear a short-sleeved shirt, if possible

If you have any questions or need assistance, please send Karlo an email at karlot@openhousecenter.org or call (925) 349-4244 (ask for Karlo).

We look forward to seeing you there!