Kinzy Vaccine

Download as pdf
Download as pdf
You are on page 1of 1
Vaccine Administration Re. os eee Nocane hd Prerinime Kony Chody I> voh™ fr hidren and Tens on sve Fant 22.2 oon vel SAN] fore administering any vaccines, give copies of all per - ; - 7 Information Statements (Iss) toed or ga represen ponves Aude eenasteeemgaarettreame (SSS At ae en's personal record wo. Be\ W 6th Ave Deauer, oo vaca yee [mane a ne Weis |e eee] sae | vce “Stoo Yet tralian | sb _ Sere) | ops Seat mm [piafac SS ae bev iesltiryaer Mumvreveiuteer PAPO RY Twig ful & Rledove he 3 ae ce Pomme Vict HE epg RINE Sls spiel So Give? eningoconal AWN [BS leg. Menacwrmcvay |MIEMAC wy | aly) MenCY) 7 hc MENA and vbency fp iA_uegs Glkach aepukehapa > Meningococcal 8 (og, MenB) Give Men ini? [- (eg. HPV2, HPVs, ~ HPV9) Give IM? | Influenza (e.g. V3, V4, cellV3, RIVS, LAIVA) : - 7 Give 1¥3,t1v4, ettv3, : — and RIV3 1M - Give LAIV4 NAS.” D> See page 1 to record hepatitis B, diphtheria, tetanus, pertussis, Hoemephils influenzae type b, polio, preumococcal, and rotavirus vaccines. How to Complete this Record 1. Record the generic abbreviation (e.g, Tdap) or the trade name foreach vaccine (se table at right) Record the funding source ofthe vaccine given as either F (federal), S (state), orP (private). Record the site where vaccine was administered a ether RA (cight ar), LA (left arm), RT (right thigh), LT (left thigh), or NAS (intranasal) 4. Record the publication date ofeach VIS as well as the date the VIS is given tothe patient. Foret the space constraints of ths form and federal requirements for documentation, a healthcare setting may want to keep a reference list of vaccinators that includes their initials and tes. 6. For combination vaccines lina row foreach antigen inthe combination 71M is the abbreviation for intramuscular, Subcut is the abbreviation for subcutaneous. Hit etn) Flr (0 FR (Pin Scere Cop ‘hoa Fuad Facto Thain Sees Final eS. roc (Snake oh Bsa Mewes Ment (658) Immunization Action Coalition « Saint Paul, Minnesota = 651-647-9009 + www.immunize.org « www.vaccineinformation.org ‘ww immunize org/eatg.¢/p 2022 pd «Item P2022 ~ page 2 (4/16)

You might also like