Click on the image to zoom

The Medical Immunization Record can be printed to send to another health care provider to document the immunization history of your patient.

This record can also be printed and placed in a patient's chart to document the immunization history including the patient's name, demographic information, VFC eligibility, vaccine types, vaccination dates, manufacturer and lot number, route and site, VIS date, and other health information.

Next: See How To... Patient Reports - Parent Immunization Record