Medical Officers of Health (send yellow page) Waikato District Health Board. Toi Te Ora Public Health
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1 Instructions This form is completed by the consenting parent and the lead maternity carer (LMC) after the birth immunisations. The white LMC page is to remain with the maternity notes. Fax, or send a photocopy, of the white page to the DHB National Immunisation Register (NIR) Administrator (details overleaf). Send the yellow page to the Medical Officer of Health (details below). Send the green page to the patient s GP. Medical Officers of Health (send yellow page) Name Districts covered Address Phone Fax Northland District Health Board Northland Public and Population Health Unit Tohora House, Carpark 15 Hospital Road, Maunu Private bag 9742, WHANGAREI Auckland Regional Public Health Service Toi Te Ora Public Health Tamaki Makaurau- Auckland Waikato Ruapehu (northern part) Bay of Plenty Lakes Auckland Service Cornwall Complex, Building 15 Greenlane Private Bag Symonds Street, AUCKLAND 1150 Population Health Services Level 5 Hugh Monckton Trust Building Cnr Rostrevor & Harwood Streets Private Bag 3200, HAMILTON 3240 Toi Te Ora Public Health 510 Cameron Road Tauranga 3110 PO Box 2120, TAURANGA 3140 Hauora Tairawhiti Gisborne/Tairawhiti Population Health Te Puna Waiora Hauora Tairawhiti Tangata Rite Building 110 Peel Street Private Bag 7001, GISBORNE 4040 Taranaki District Health Board Taranaki Public Health Unit Barrett Building Tukapa Street Private Bag 2016, NEW PLYMOUTH 4342 Hawkes Bay District Health Board MidCentral District Health Board Nelson-Marlborough Public Health Service Community and Public Health Hawkes Bay Manawatu, Tararua, Horowhenua, Palmerston North City Whanganui, Ruapehu (Southern part) and Rangitikei Wellington Hutt Valley Wairarapa Nelson Marlborough Canterbury South Canterbury West Coast Hawkes Bay DHB, Population Health Napier Health Centre 1st Floor 76 Wellesley Road PO Box 447, NAPIER 4140 Public Health Unit Community Health Village Palmerston North Hospital PO Box 11036, PALMERSTON NORTH 4440 Public Health Centre Lambie Hostel Wanganui Hospital Private Bag 3003, WHANGANUI 4540 Hutt District Health Board Level 1, Community Health Building Hutt Hospital Private Bag , LOWER HUTT 5040 Nelson Marlborough Public Health Service Nelson Marlborough District Health Board Nelson 281 Queen Street, Richmond PO Box 647, NELSON 7040 Blenheim Office 22 Queen Street PO Box 46, BLENHEIM 7240 Community and Public Health Canterbury District Health Board 310 Manchester Street PO Box 1475, CHRISTCHURCH 8140 Public Health South Otago Public Health South Main Block, Level 2 Wakari Hospital Taieri Rd Private Bag 1921, DUNEDIN 9054 Southland Public Health South 23 Forth Street PO Box 1601, INVERCARGILL 9840 (09) (09) (09) (09) (07) (07) (07) (06) (06) (06) (06) (06) (06) (06) (06) (06) (06) (04) (04) (03) (03) (03) (03) (03) (03) (03) (03) (03) (03)
2 DHB s (send white page) District Health Board Address Phone Fax Auckland (09) (09) HealthWEST PHO PO Box Lincoln North, Auckland 0654 Bay of Plenty Capital & Coast Counties Manukau Canterbury Hawkes Bay Hutt Valley Lakes MidCentral Nelson-Marlborough Northland South Canterbury Southern (Otago) Southern (Southland) Tairawhiti Taranaki Waikato Wairarapa Waitemata West Coast Whanganui National Immunisation Register Private Bag Tauranga 3143 Kenepuru Hospital Raiha St PO Box Porirua 5240 Counties Manukau District Health Board Private Bag Otahuhu, Auckland 1640 Canterbury District Health Board PO Box 800 Christchurch 8140 Hawkes Bay District Health Board Public Health Unit Napier Health Centre PO Box 447 Napier 4140 Hutt Valley District Health Board Private Bag Lower Hutt 5040 Lakes District Health Board Pukeroa Hill Private Bag 3023 Rotorua 3046 MidCentral District Health Board Private Bag Palmerston North 4442 Nelson Marlborough District Health Board PO Box 647 Nelson 7040 Northland District Health Board PO Box 742 Whangarei 0140 Primary Community Services South Canterbury District Health Board Private Bag 911, Timaru 7940 Public Health South Private Bag 1921, Dunedin 9054 Vaccine Preventable Disease Team PO Box 828, Invercargill 9840 Tairawhiti District Health Board Private Bag 7001 Gisborne 4040 David St Private Bag 2016 New Plymouth 4342 PO Box 934 Hamilton 3240 Wairarapa PHO PO Box 314 Masterton 5840 HealthWEST PO Box Lincoln North, Auckland 0654 West Coast District Health Board Community Services PO Box 387 Greymouth 7840 Whanganui District Health Board Private Bag 3003 Wanganui 4540 (07) (07) (04) (06) (07) (04) (07) (03) (03) (06) (04) (04) (07) Toll free from Taupo and Turangi: (07) (07) (06) (03) (09) (03) (03) (03) (03) (03) (06) Ext (06) (06) (06) (07) (06) (06) (09) (09) (03) (03) (06) (06)
3 Male Female Alternative I consent / do not consent (delete which is not applicable) to the above child receiving the hepatitis B vaccine at birth. I consent / do not consent (delete which is not applicable) to this form being given to the Medical Officer of Health, the and the patient s GP to Protocols and record of vaccines given: Codes: RVL Right Vastus Lateralis (outer thigh); LVL Left Vastus Lateralis (outer thigh); RD right deltoid (upper arm); LD left deltoid (upper arm); O Other. Key: Hep B = hepatitis B vaccine; HBIG = hepatitis B immunoglobulin; DTaP-IPV- = diphtheria, tetanus, Fax/post a copy of the white page to the DHB. Lead maternity carer
4 Male Female Alternative I consent / do not consent (delete which is not applicable) to the above child receiving the hepatitis B vaccine at birth. I consent / do not consent (delete which is not applicable) to this form being given to the Medical Officer of Health, the and the patient s GP to Protocols and record of vaccines given: Codes: RVL Right Vastus Lateralis (outer thigh); LVL Left Vastus Lateralis (outer thigh); RD right deltoid (upper arm); LD left deltoid (upper arm); O Other. Key: Hep B = hepatitis B vaccine; HBIG = hepatitis B immunoglobulin; DTaP-IPV- = diphtheria, tetanus, Fax/post a copy of the white page to the DHB. Medical Officer of Health
5 Male Female Alternative I consent / do not consent (delete which is not applicable) to the above child receiving the hepatitis B vaccine at birth. I consent / do not consent (delete which is not applicable) to this form being given to the Medical Officer of Health, the and the patient s GP to Protocols and record of vaccines given: Codes: RVL Right Vastus Lateralis (outer thigh); LVL Left Vastus Lateralis (outer thigh); RD right deltoid (upper arm); LD left deltoid (upper arm); O Other. Key: Hep B = hepatitis B vaccine; HBIG = hepatitis B immunoglobulin; DTaP-IPV- = diphtheria, tetanus, Fax/post a copy of the white page to the DHB. General Practitioner
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