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Get Immunize P2022 2016

The child’s parent or legal representative and make sure he/she understands the risks and benefits of the vaccine(s). Always provide or update the patient’s personal record card. Vaccine Type of Vaccine1 Date vaccine Funding given Source (mo/day/yr) (F,S,P)2 Site3 Chart number practice name and address Vaccine Information Statement (VIS) Vaccine Lot # Mfr. Date on VIS4 Date given4 Vaccinator5 (signature or initials and title) Hepatitis B6 (e.g., HepB, Hib-HepB, DTaP-HepB-IPV) G.

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