Table. Pre-vaccination screening checklist
Pre-vaccination screening checklist |
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This checklist helps decide about vaccinating you or your child today. Please fill in the following information for your doctor/nurse. Name of person to be vaccinated: Date of birth: Age today: Name of person completing this form: Please indicate if the person to be vaccinated:
Please specify:
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Note: Please discuss this information or any questions you have about vaccination with your doctor/nurse before the vaccines are given. Before any vaccination takes place, your doctor/nurse should ask you:
It is important for you to receive a personal record of your vaccinations or your child’s vaccinations. If you do not have a record, ask your doctor/nurse to give you one. Bring this record with you every time you or your child visit for vaccination. Make sure your doctor/nurse records all vaccinations on it. |