Screening Checklist for Contraindications to Vaccines for Adults patient name date of birth / / For patients: The following questions will help us determine which vaccines you may be given today. If you answer “yes” to any question, it does not necessarily mean you should not be vaccinated. Screening checklist for contraindications to HPV, MenACWY, MenB, and Tdap vaccines for teens Form your patients (or parents of teens) fill out to help you evaluate which vaccines can be given at that day's visit, includes information sheet for healthcare professionals [#P4062].
Get the latest CDC recommendations for immunization of adults. Implement standing orders [3 pages] External or protocols. Make vaccine assessment and vaccination a routine part of patient office visits. Earn CME credits from the American Medical Association by learning about Adult Vaccinations and Team-Based Immunization External. Screening Questionnaire for Adult Immunization Did you bring your immunization record card with you?!yes! no It is important for you to have a personal record of your vaccinations. If you don™t have a record card, ask your healthcare provider to give you one! Bring this .
Screening Questionnaire for Adult Immunization Immunization Action Coalition • 1573 Selby Ave. • St. Paul, MN 55104 • (651) 647-9009 • www.immunize.org • www.vaccineinformation.org Technical content reviewed by the Centers for Disease Control and Prevention, February 2008. Adult Immunization Patient Intake Form pdf icon [2 pages] FEB 2015 Distribute the form to your adult patients at appointment check-in to help facilitate the vaccine conversation. Customizable for your practice’s contact information. Size and orientation: 8-1/2″ .