When you are vaccinated at a medical institution outside the city

　If you would like to receive a vaccination in a municipality other than Yokohama City, please consult with your ward office Health Promotion Section in advance.
Based on the Vaccination Law, when receiving vaccinations at a medical institution outside the city, we will issue a “Vaccination Implementation Request Form”, which is a document that clarifies that The Mayor of Yokohama is responsible for the implementation.
　In addition, vaccination costs will be borne by you in principle.

・Return home birth outside the city (After July 1, 2020, refunds (reimbursement payment) of expenses for all periods is now possible.)
・During inpatient treatment at a hospital outside the city
※Streptococcus pneumoniae for adults and influenza Vaccinations are not eligible.

(The application form is also available in Health and Welfare Center.)
“Vaccination Implementation Request Form Issuance Application Form” Form printing (outside site)
※Please print it out from the link.

You can also apply by phone or fax.　（Contact information of each ward Health and Welfare Center）

(It takes about 1 to 2 weeks from application acceptance to shipping.)

1 Name of recipient Please fill in the name and reading of the person receiving Vaccinations.
2 Date of birth Please fill in the date of birth of the person receiving Vaccinations.
3 Please fill in the postal code, Address and Phone number for Yokohama where Address resident certificate is located.
4 Parents' name Please indicate the relationship between the person receiving the Vaccinations and the relationship between the person receiving the vaccination.
5 If the applicant's name is not a guardian, please fill in the relationship between the name and the person receiving the vaccination.
6 Reason for issuance Regarding the reason for issuance, circled (or check) to the relevant number and select items as necessary.
Please describe it.
7 Type of Vaccinations Please mark the Vaccinations where you wish to issue a Vaccinations request form.
8 Scheduled date of vaccination / medical institution The scheduled vaccination date, medical institution (or public health center, etc.) that will receive the vaccination
Please fill in your name, Address and doctor's name.
9 If you are staying in a place other than your current address in Address,Address and Phone number.
10 Please mark the corresponding number and write required items.