Transcription of 317 Adult Vaccine Daily Usage Log Date: Ordering …
1 317 Adult VaccineDaily Usage Log INSTRUCTIONS: Keep this log near your vaccines. Fill in today s date and patient info then make a check for each Vaccine administered. At the end of the day, write the number of vac-cines administered under Daily Total. Before Ordering vaccines, add up the Daily totals since the previous order and record under Order Period Total. File all Usage logs for three years. To d ay s DatePatient Name (or medical record)Date of BirthHep A VAQTA HavrixHep B Engerix B HPV Gardasil 9MC V4 Menactra MenveoPC V13 Prev- nar13 PPSV23 Pneu-movax23 RZVS hingrixTd Td Vaccine (Grifols) Td ap Adacel BoostrixHZV Zostavax MMR MMR-IIVAR VarivaxDaily Total:PAGE OFLog taken by:Order Period Total: IMM-1053 317 (8/18)Date: Ordering Period: __/__/__ to __/__/__FROZENREFRIGERATED
