Dear Parent/Guardian:
Upper Missouri District Health Unit with Elbowoods Memorial Health are happy to be able to provide Influenza and covid vaccinations at your child’s school this year Monday October 7th from 3pm-6pm in the Elementary School Cafeteria. We encourage all children to get vaccinated against Influenza.
Influenza (“flu”) is a contagious disease that can be spread by coughing, sneezing, and close contact. Your child is likely to be exposed to this every day in school! A few but not all symptoms of Influenza are shortness of breath, fever/chills, sore throat, muscle aches, fatigue, cough, headache, or runny/stuffy nose.
Tribal members will receive vaccinations free of cost through Elbowoods Memorial Health Center
Non- Tribal members
Payment is determined by the following conditions:
*Blue Cross/Blue Shield, Sanford Health, United Health Care, Meritain, Medica or Aetna: Please provide all your policy information and we will bill directly. If payment applies, you will be billed from UMDHU.
*Medicaid: We will file with North Dakota Medicaid only. Please provide your Medicaid #.
*Other Insurance (Any Health Insurance other than the ones listed above): Please send a check, cash, or money order for $65 per flu shot per child. Well send a receipt to you after vaccination. Please file receipt with your insurance company to receive reimbursement.
*No Insurance: Please send a check, cash, or money order for a recommended payment of $21 per shot per child with the completed form to the school secretary. Checks and money orders can be made out to UMDHU.
Please review the enclosed information and return the Vaccine Administration Form to your school’s secretaries by the day of the vaccine clinic. Please feel free to call 701-628-2951 with any questions.
Please answer the health questionnaire on the back side of the form.
Sincerely, Crystal Snow
Becky Fladeland RN Elbowoods Memorial Health Center
Upper Missouri District Health- Stanley 701-6277921
701-628-2951