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Test/Immunization Record

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SKU: 2123

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

Download a sample today!

·       Size: 8 ½” x 11”

·       Prints two-sides, black ink

·       Punched 5-holes top and side

·       100 per pad

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