Test/Immunization Record - DIGITAL FORM
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Updated August 2023
The Briggs Test/Immunization Record provides for documentation of tuberculin testing/screening and immunizations/vaccinations routinely provided in a post-acute care setting: AL, SNF/NF, RCF, etc.
Prompts for documentation include dates, clinician administering the test or the vaccination, consent, site, lot number, expiration date and results/reactions and includes:
• | TB Screening |
• | COVID-19 Vaccines |
• | Pneumococcal Vaccines |
• | Influenza Vaccines |
• | Herpes Zoster Vaccines |
• | Hepatitis A Vaccine |
• | Hepatitis B Vaccine |
• | Tetanus/Diphtheria/Pertussis (Td/Tdap) Vaccine |
• | Respiratory Syncytial Virus (RSV) Vaccine |
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*This digital form is delivered as a form-fillable PDF and includes 1-year of updates. To receive your electronic file and updates you must complete and return a content license agreement and provide an end-user email address and contact name for file delivery (please allow 2-3 business days for order fulfillment). After 1- year, your update subscription will automatically renew.