Religious Exemption Q and A
Religious Exemption Form/Completion Instructions
This program provides immunizations to adults and children in Lake County throughout the year.
At the family immunization clinics, children can be immunized with all recommended and required routine immunizations. Children aged 18 years and younger who receive our services MUST be eligible for the Federal Vaccine For Children program:
- Child receives Medicaid
- Child is American Indian or Alaskan Native
- Child does not have any insurance (other than Medicaid or All Kids)
- Child has health insurance but it does not cover vaccines, or it has a limitation on vaccine coverage, or it does not cover the vaccines that the child is receiving at that visit.
The only vaccine we carry for children 18 years and younger who are not VFC eligible is the influenza (flu) vaccine.
Parents or guardians must bring Parents or guardians must bring Parents or guardians must bring Parents or guardians must bring Parents or guardians must bring immunization Parents or guardians must bring immunization records of their children with them. If a child has an immunization letter from a school nurse, it should be brought to the clinic.
Consent by Proxy Form
Consent by Proxy Form (Spanish)
Click here for information about getting a copy of your immunization record.
Immunizations cost $16.00 per shot, but no child is turned away due to a lack of ability to pay. There is no co-pay for Medicaid recipients.
We no longer carry most vaccines for adults. These can be obtained at your private provider’s office or at most pharmacies. However, we do continue to carry influenza, Pneumonia, and Tdap vaccines. Immunizations are also provided to adults during our family clinics.
|Adult Vaccine Charges
||# Doses in a Primary Series
||Covered by Medicaid?
||Covered by Medicare Part B?
||$29.00 per dose
(Charge increases for recombinant shot or high-dose shot)
|Flu Nasal Mist
||$39.00 per dose
||$98.00 per dose
||$54.00 per dose