**This is a HIPPA Compliant Form***
ABOUT Childress Nursing Services (CNS)
CNS is a WA state licensed home health agency and mobile clinical laboratory based in Renton, WA that primarily provides fertility and maternal in-home medication injections and support to clients in King, Pierce, and Snohomish counties. Our home health agency is uniquely composed exclusively of licensed nurses. We do focus on serving women from preconception to post-delivery; however, due to the need to have all hands on deck to fight the pandemic, we have decided to join in the efforts to vaccinate Washingtonians against the SARS-CoV-2 virus that causes Covid-19 by providing Covid-19 vaccine home injections.
COVID-19 HOME VACCINATION SUPPORT
Our Covid-19 Vaccine teams will be composed of a 2-person nursing unit and all of our staff are vaccinated. These small units are mobile and highly portable, making it the perfect option to maneuver in and out of small spaces.
Currently, our primary objective is connecting with homebound individuals living within an adult household of 5 or more people seeking to become vaccinated who are unable to travel to a vaccination site for various reasons. This will include vaccination for the homebound individual(s) and their other household members, up to 10 members/household - minimum 18 years of age. This can include individuals who frequently visit their homes, such as caregivers and extended family members/friends. We will accept referrals for up to 1 homebound individual living alone; however, households with 5 or more people that can be vaccinated will be prioritized.
FOR ORGANZATIONS SEEKING TO HOST "POP-UP STYLE" MINI VACCINATION SESSIONS
CNS will service approximately 5 – 30 people/event. You are responsible for the venue (i.e. setup, breakdown, cleaning) and all costs related to hosting at that location. You will need to supply 1-2 support volunteers from your organization who will be present during the entire vaccination session. Additionally, if your referrals require an interpreter (all CNS nurses are fluent in English), then you will be responsible for providing an interpreter for the event. Ideally, one of the volunteers will be your organization's Point of Contact person and can serve as an interpreter/translator. CNS will provide the vaccine, nurse vaccinators and supply all medical equipment and supplies needed for the event.
*Note: Referrals being vaccinated are still responsible for completing their individual CNS registration form before appointment confirmation. For organizations containing members who are disabled or unable to complete the registration form for various reasons, like illiteracy, non-English reading, then you must designate personnel within your organization or another household representative who will be responsible for completing the registration form for that individual(s). A link to the registration form will be sent to your organization to disburse to the household(s) being referred.