+19 Flu Vaccine Administration Record Template. Enter vaccine lot #, expiration date and site of administration, then scan the. Record the date of vaccination and the name/location of the administering clinic.
Flu offline vaccination record form1. Information and screening question responses. (pdf 1.52 mb) (english and spanish) (updated october 2018) vaccine ordering, storage and handling.
Flu offline vaccination record form1. Update demographic information and complete at each vaccine administration. Health care providers who administer vaccines covered by the national vaccine injury compensation program (vicp) are required under the national childhood vaccine.
Record the date of vaccination and the name/location of the administering clinic. This vaccine is appropriate for this patient based on the responses to the screening questions and age guidelines according to acip. Do not complete the form if you.
We want to make certain that you have information about the vaccines or antibody product we administered so you can update your patient’s medical record. Flu vaccine administration record if you are receiving your flu vaccine from an outside provider, please ask them to document all required information listed below. Understand the benefits and risks of the vaccine and request that the vaccine indicated on this form be given to me or the person named on this health record for who i am authorized to.
** please forward flu vaccine records to your member flu vaccination coordinator. Record the generic abbreviation (e.g., tdap) or the trade name for each vaccine (see table at right). Please contact us if you have.
(pdf 1.52 mb) (english and spanish) (updated october 2018) vaccine ordering, storage and handling. To record influenza, pneumococcal, zoster, hib, and other vaccines (e.g., travel vaccines). Update the patient’s record with any new allergy, health condition or primary care provider information.
