Influenza (FLU) Vaccination
Your school is partnering with Health4Chicago to offer Influenza (FLU) vaccines to students, staff, parents, and siblings. Please fill out a registration form for each family member you wish to be vaccinated. Please read through the Notice of Privacy Practices. You may either scan the signed forms and email them as PDF or JPEG attachments to immunizations@uchospitals.edu or fax them to 773.753.8230, Attention: Jenny Atilano
Student FLU Vaccine Registration
ADULT Registration Form
Please understand your benefits and insurance coverage. It is your responsibility as a patient to know what services are covered by your insurance plan and what additional fees will be owed. Children uninsured or covered by Medicaid will be given vaccines FREE of charge to parents. Note: The University of Chicago will enter your immunization information into a statewide registry called the Illinois Comprehensive Automated Immunization Registry Exchange (ICARE). This service allows providers across the state to access your immunization record when necessary and ensures this information is kept in a secure place accessible to your healthcare providers. If you wish to opt-out of this service, please indicate that either on your consent form or via email/ fax.
Notice of Privacy Practices
NPP Acknowledgement Form
Frequently Asked Questions
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