See at a glance the complete record of resident, employee or volunteer TB tests/immunizations/vaccinations!
Updated to include COVID-19 vaccines, this form provides for recording essential information for each test/vaccine administered, including results/reactions, lot numbers, site, etc. For immunizations that are not ordered annually, indicate year received, if known.
• TB Screening
• COVID-19 Vaccines
• Pneumococcal Vaccines - PPSV23 and PCV13
• Influenza Vaccines - Standard Trivalent, High Dose Trivalent, Quadrivalent, Other
• Herpes Zoster Vaccines
• Hepatitis B Vaccine
• Tetanus Toxoid Vaccine
• Tetanus/Diphtheria (Td) Vaccine
· Size: 8 ½” x 11”
· Prints two-sides, black ink
· Punched 5-holes top and side
· 100 per pad