Transcription of Vaccine Administration Record for Adults
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Vaccine Administration Record for Adults
Page 1 0f 2. Vaccine Administration Record Patient name Birthdate Chart number for Adults practice name and address Before administering any vaccines, give the patient copies of all pertinent Vaccine Information Statements (VISs) and make sure he/she understands the risks and benefits of the Vaccine (s). Always provide or update the patient's personal Record card. Vaccine Information Date Vaccine Funding Route3 Vaccine Statement (VIS) Vaccinator5. Type of Vaccine Vaccine1. given Source and (signature or (mo/day/yr) (F,S,P)2 Site3 Lot # Mfr. Date on VIS4 Date given4 initials and title). Tetanus, Diphtheria, Pertussis ( , Tdap, Td). Give Hepatitis A. ( , HepA, HepA-HepB6). Give Hepatitis B1. ( , Engerix-B, Recombi- vax HB, Heplisav-B, HepA-HepB6). Give Human papillomavirus (HPV2*, HPV4*, HPV9). Give Measles, Mumps, Rubella (MMR) Give Varicella (chickenpox,VAR). Give Meningococcal ACWY. ( , MenACWY, MPSV4*). Give MenACWY Meningococcal B. ( , MenB). Give MenB *HPV2, HPV4, and MPSV4 vaccines are no longer available in the , but should be included in patient records for historical purposes.
3.Record the route by which the vaccine was given as either intramuscular (IM), subcutaneous (Subcut [SC]), intradermal (ID), intranasal (NAS), or oral (PO) and also the site where it …
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