Test/Immunization Record - DIGITAL FORM
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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.
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*SUBSCRIPTION: Form access is licensed for 1-year per agency/facility location. Multiple sites require a quote. This digital form is delivered as a form-fillable PDF and includes 1-year of updates. To receive your electronic file and updates you must complete and return a content license agreement and provide an end-user email address and contact name for file delivery (please allow 2-3 business days for order fulfillment) and provide the facility/agency address. After 1- year, your subscription will automatically renew.
All Briggs Digital on Demand products require a credit card payment (or pre-payment) to receive digital files electronically.
Briggs Healthcare does not allow use of any of its intellectual property without a valid license and payment of fees.
Delivery: Digital*
DIGITAL/ELECTRONIC MERCHANDISE & SUBSCRIPTIONS: ALL DIGITAL AND ELECTRONIC PRODUCTS AND SUBSCRIPTIONS ARE NON-REFUNDABLE AND NON-RETURNABLE.
*SUBSCRIPTION: Form access is licensed for 1-year per agency/facility location. Multiple sites require a quote. This digital form is delivered as a form-fillable PDF and includes 1-year of updates. To receive your electronic file and updates you must complete and return a content license agreement and provide an end-user email address and contact name for file delivery (please allow 2-3 business days for order fulfillment) and provide the facility/agency address. After 1- year, your subscription will automatically renew.
All Briggs Digital on Demand products require a credit card payment (or pre-payment) to receive digital files electronically.
Briggs Healthcare does not allow use of any of its intellectual property without a valid license and payment of fees.