For those wishing to receive vaccinations outside of Inagi City

Procedures for requesting vaccination outside the city

• Vaccination is generally requested to be administered at designated medical institutions within Inagi City.
• If you wish to receive a vaccination at a medical institution other than the designated medical institutions in Inagi City due to unavoidable circumstances, please complete the procedure for issuing a Vaccination Request Form in advance, and by receiving the Vaccination Request Form from the city, you will be able to receive a refund (reimbursement) for the costs associated with the vaccination.
• Application Form for Issuance of Vaccination Request can be downloaded from below.

• Application Form for Issuance of Vaccination Request (PDF 258.3KB)
• Application Form for Issuance of Vaccination Request Form (Word 17.1KB)

Note: When entering your phone number, please provide a number where you can be reached during the day.

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About the Target Audience

On the day of vaccination, those who are registered residents of Inagi City, are of the eligible age for vaccination, and for any of the following reasons find it difficult to receive vaccination at designated medical institutions within the city

・Because I am home for childbirth and currently visiting my hometown

- Because I will be returning to my parents' home for childbirth and will be taking my older child with me

- Because the mother, father, grandparents, etc. are ill, and the child will leave Inagi City with them

・For physical and mental recovery after childbirth

- Because I have a chronic illness and wish to be vaccinated at my regular medical institution

・Because you are staying in another municipality for medical treatment

・Because currently admitted to the facility

・Due to hospitalization

・Other cases where the mayor recognizes that vaccination at a medical institution other than the designated one is appropriate

Note 1: This applies to those who are registered residents of Inagi City on the day of vaccination. Please be aware if you are planning to move out.

Note 2: Even if you do not fall under the above categories, you may still be eligible. If you have any questions, please contact the Inagi City Health Center.

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About Eligible Vaccinations

The vaccinations eligible are as follows.
However, this only applies to those who have received the prior issuance of the vaccination request form and have adhered to the target age and appropriate vaccination intervals.

• Hib
• Pneumococcal for Children
• Hepatitis B
• Five-Component Mixture
• Quadrivalent Combination
• Triple Combination
• Polio
• BCG
• Rotavirus
• Measles and Rubella Combined (MR)
• Chickenpox
• Japanese Encephalitis
• Type 2 Mixed
• Cervical Cancer
• Pneumococcal for Older Adults
• Older Adults Shingles (Routine Vaccination)
• Influenza for Older Adults (Note: Cost assistance will be provided from mid-October to late January of the following year for those who meet one of the following criteria: 1. Individuals aged 65 and older 2. Individuals aged 60 to under 65 who have a disability that severely limits daily life due to heart, kidney, respiratory function, or immune function impairment caused by the human immunodeficiency virus.)
• COVID-19 Vaccination for Older Adults (Note: Cost subsidies will be provided from around mid-October to late March of the following year for those who meet either 1 or 2 below. 1. Persons aged 65 and over 2. Persons aged 60 to under 65 who have disabilities that severely limit daily life due to heart, kidney, or respiratory function, or immune function caused by human immunodeficiency virus)
• Shingles (Voluntary Vaccination Subsidy Program)
• Mumps (Voluntary Vaccination Subsidy Program)

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Flow of Procedures

1 Application for Issuance of Vaccination Request Form

In order to issue the Vaccination Request Form, you must submit an Application Form in advance.
Please fill out the necessary information on the "Vaccination Request Form" (A4 size) and submit it in person or by mail to the Health Division (Health Center).
The application form can be obtained by any of the following methods.

• Download and print from above
• Directly available at the Health Center and Hirao/Wakabadai Branch Office
• Mailing (Note: If you wish to receive by mail, please contact the Health Center)

Note: Older Adults pneumococcal vaccination, shingles regular vaccination, Older Adults influenza vaccination, and Older Adults COVID-19 vaccination. If you wish to receive the vaccination outside the city and meet the criteria below, please attach a certificate to the Application Form.

• Individuals Receiving Public Assistance (Public Assistance Certificate)
• Individuals receiving support benefits as Chinese remaining nationals (copy of the identification certificate for the support benefit certificate)
• (For Vaccination against pneumococcal pneumonia, influenza, and COVID-19 for Older Adults) Individuals aged 60 to under 65 with disabilities in heart, kidney, or respiratory function, or with immune function impairment due to HIV (copy of Physical Disability Certificate Class 1)
• (In the case of regular vaccination for herpes zoster in older adults) For those aged 60 to under 65 with immune dysfunction caused by the human immunodeficiency virus (copy of Physical Disability Certificate Grade 1)

Submission Destination for Application Form

Postal Code 206-0804, 112-1 Momura, Inagi City Health Center
To: Vaccination Section, Health Division, Inagi City

2 Issuance and Sending of "Vaccination Request Form" etc. from Inagi City

After the Mayor of Inagi City receives the Application Form, the necessary documents for receiving vaccinations outside the city (Vaccination Request Form, Pre-vaccination Questionnaire, Vaccination Cost Subsidy Application Form, etc.) will be mailed to the address specified by the applicant.

It takes about 1 to 10 days to issue the Vaccination Request Form. Please allow ample time for the application process before the scheduled vaccination date.

3 Vaccination at Medical Institutions

Please receive the vaccination at a medical institution after receiving the documents sent by the city.

Items to Bring on the Day of Vaccination

1. Vaccination Request Form
2. Pre-examination Questionnaire of Inagi City
3. Identity Verification Documents (Health Insurance Card, Driver's License, etc.)
4. Maternal and Child Health Handbook or vaccination certificate

After completing the vaccination, please pay the vaccination fee at the medical institution's reception, be sure to receive the "Pre-examination Form (City Copy) " and "Receipt", and keep them carefully until you apply for the subsidy to Inagi City.
Note: If you wish to receive financial assistance from Inagi City's subsidy program, you will need to initially cover the vaccination costs.

4 Application for Vaccination Subsidy for Inagi City

Required Documents for Application

• Pre-examination Questionnaire (For City Record)
• Receipt (Original) Note: A document certifying that the vaccination fee has been paid
• Application Form for Vaccination Subsidy in Inagi City, etc.

Note: Please check the documents sent by the city along with the vaccination request form for details on the required documents.

Application Destination

Please submit to the Inagi City Health Center counter in person or by mail.
[Submission Destination]
Postal Code 206-0804, 112-1 Momura, Inagi City Health Center
To: Vaccination Section, Health Division, Inagi City

Application Deadline

Within one year after vaccination completion

• Note 1: The application deadline for shingles (optional vaccination subsidy program) may differ from the above. Please check the documents sent by the city along with the Vaccination request form for the application deadline.
• Note 2: If you are applying by mail, please ensure that the documents arrive by the application deadline.

Subsidy Amount

There is a limit to the amount of assistance for vaccination costs. Please check the documents sent by the city for details.

About the Grant Decision

After the application, if the issuance is decided, a "Notification of Issuance Decision for Vaccination Subsidy in Inagi City" will be sent by mail.
Note: If we are unable to provide the subsidy due to reasons such as not meeting the eligibility requirements, we will send a notification titled "Notification of Non-Granting of Inagi City Vaccination Subsidy" by mail.

About Payment

The grant will be transferred to the designated account approximately one month after the application date.

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[Reference] When receiving regular vaccinations for children at medical institutions in Hachioji, Machida, Hino, and Tama City

Regarding regular vaccinations for children, an agreement was made in fiscal year 2015 among the five cities in the Minami-Tama Health and Medical Area (Inagi City, Hachioji City, Machida City, Hino City, and Tama City), and the above procedures are not required. You can receive vaccinations at any medical institution that conducts them in each city.
For information about the medical institutions in the neighboring four cities, please check the link below.

• Hachioji City Designated Medical Institution(External Link)
• Designated Medical Institutions in Machida City(External Link)
• Designated Medical Institutions in Hino City(External Link)
• Tama City Designated Medical Institutions(External Link)

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