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Vaccine Administration Record - Pack of 100

Designed to keep track of all pertinent data, this heavyweight 8-1/2" x 11" card also provides space for parent or legal guardian approvals.

Forms and Charts
Item #: HE0116

Retail: $27.50
Members: $22.00
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Best Seller!

Revised to include rotavirus and HPV vaccines. Designed to keep track of all pertinent data, this heavyweight 8-1/2" x 11" card also provides space for parent or legal guardian approvals. Three-hole punched and includes space to record the following information for 12 different immunizations:

  • Date given (month/date/year)
  • Age and injection site
  • Source of vaccine (federal, state, or private)
  • Vaccine manufacturer and lot number
  • Vaccine information materials publication date
  • Initials of vaccine administrator
  • Initials of parent or legal guardian

Sold in packs of 100 forms.

Vaccine Administration Record - Pack of 100
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