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Corporate Flu Clinic Request Form 2008-2009 Season


Corporate Flu Clinic Request Form 2008-2009 Season

*Corporation Name
*Corporation Address
*City
*State
*Zip
Contact person:
Contact Phone
Fax
E-mail

Insurances covering Flu: BC/BS, Preferred Care, MPV, Medicare

Will your company pay for employees not covered by above insurance? Yes No

Will your company pay for un-insured employees? Yes No

Best Day(s) of the week for clinic Sun Mon Tues Wed Thurs Fri Sat

Best Time Period(s) before 9am early am late am early afternoon late afternoon eves

How many hours do you want the clinic to run?

Approximately how many employees to receive flu shots ?

Thank you

Comments?


 

 

 

FLU PREVENTION IN THE WORK PLACE

The Center for Nursing Entrepreneurship offers your company:

  • On-site flu vaccination clinics
  • Convenient times for your employees
  • Direct billing to most local health care insurers
  • A reasonable clinical cost
  • Professional Registered Nurses
  • Vaccine and supplies
  • Full compliance with all New York State and federal clinic standards and guidelines

What is supplied:

  • Registered Nurses
  • Vaccine
  • Supplies for Vaccine Administration

On-site cost of RN labor and supplies:

  • $150.00 for 1 RN for 1st hour
    • Waived if Company has 100 or more vaccinated.
  • $50.00 for each additional RN
  • $50.00 for each additional hour

Insurance Coverage:

See insurance information
$30.00 fee per vaccination for all other individuals, payable by cash or
check made payable to Health Checkpoint.

Rebecca Locke at (585)273-5271
Rebecca_Locke@urmc.rochester.edu

*We are no longer able to accept credit card payments

CNE

fight the flu