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Test/Immunization Record

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SKU: 2123

Updated 2021

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 date, who administered the test or the vaccination, consent, site, lot number, expiration date and results/reactions.


·         TB Screening

·         COVID-19 Vaccines and Boosters

·         Pneumococcal Vaccines -  PPSV23, PCV13, PCV20

·         Influenza Vaccines - Standard Trivalent, High Dose Trivalent, Quadrivalent, Other

·         Herpes Zoster Vaccines

·         Hepatitis B Vaccine

·         Hepatitis A Vaccine

·         Tetanus/Diphtheria/Pertussis (Td/Tdap) Vaccine

·        2 blank spaces left for recording other vaccines not routinely administered for all patients/residents, employees, or volunteers

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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