Test/Immunization Record
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 |
· Size: 8 ½” x 11”
· Prints two-sides, black ink
· Punched 5-holes top and side
· 100 per pad