Get Tdap Sample 2020-2025

Filling out the Tdap Sample form online is a straightforward process that ensures individuals receive the necessary immunizations. This guide provides clear steps to assist users in completing the form accurately and efficiently.

Follow the steps to fill out the Tdap Sample form online

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Review the statement in section one, confirming agreement that the individual named will receive the Tetanus and Diphtheria (Td) vaccine. Ensure you check the box to confirm your understanding.
3. In the ‘Information about person to receive vaccine’ section, print the individual’s name accurately in the designated fields — Last name, First name, and Middle Initial.
4. Enter the birthdate of the individual in the format mm/dd/yy. This is essential for record-keeping.
5. Circle the appropriate sex designation (M or F) of the individual receiving the vaccine.
6. Fill in the complete address of the individual, which includes Street, City, County, State, and Zip code.
7. In the ‘For Clinic/Office Use’ section, record the necessary clinic or office address as well as the date the vaccine was administered.
8. Document the vaccine manufacturer and lot number, which can be provided by the administering clinic.
9. The form requires a signature from the individual receiving the vaccine or an authorized person, such as a parent or guardian. Ensure the signature is clearly written followed by the date.
10. Include the site of administration where the vaccine was given and have a witness sign if required.
11. Lastly, add the signature of the vaccine administrator and their title to complete the document.
12. Once all fields are filled out correctly, save your changes. You can then download, print, or share the form as needed.

Complete your documents online to ensure timely immunizations.