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Test/Immunization Record

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$29.95
SKU: 2123
$29.95

Updated 2024
This updated form provides a centralized location to document routine immunizations for the post-acute population. It features expanded space to record multiple influenza, pneumococcal, and COVID-19 vaccines, as well as TB screening, Herpes Zoster, Hepatitis A and B, Td/Tdap, and RSV vaccines.

Designed for long-term tracking, it allows clinicians to document more than a year’s worth of vaccine administration and capture key details—administration dates, administering clinician, injection site, lot number, expiration date, results, and reactions.


Download a sample today!

·Size: 11” x 8 ½"

·Prints two-sides, black ink

·Punched 5-holes top and side

·100 per pad

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