SAMPLE IMMUNIZATION RECORD

SAMPLE IMMUNIZATION RECORD. PART I. Name. Last Name First Name. Address. Street City State Zip. Date of Entry / Date of Birth / / Social Security Number ...

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Vaccination records (sometimes called immunization records) provide a history of all the vaccines you or your child received.

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For hepatitis B and meningococcal B vaccines (MenB or MenABCWY), record the trade name (see table at left); for all other vaccines, record the standard.2 pages

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If the TST method is used, record the dates and results of two 1-step annual. TSTs over the last two years, or of one 2-step TST protocol (two TSTs performed ...

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This is a lifetime immunization record. Please bring it with you every time you visit a doctor or nurse and ask them to record the visit and immunizations ...4 pages

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You can get a copy of an immunization or vaccine record for yourself or your child using My Vaccine Record. You will need a valid form of identification.

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VACCINES THAT MAY BE RECORDED ON IMMUNIZATION RECORDS. Abbreviations for Vaccines. Abbreviations. Vaccine. DT. Pediatric Diphtheria and Tetanus. DTaP.1 page

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Record the standard abbreviation (e.g., Tdap) or the trade name for each vaccine (see table at left). Use trade name for HepB if vaccinating an older teen ...

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I am requesting a copy of the NJIIS Immunization Record for the above-named person. I hereby authorize the New Jersey Department of Health to release a copy of ...1 page

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