Get - Health Utah

This guide provides a comprehensive overview of how to accurately fill out the Vaccine Administration Record for Children and Teens. Following these clear and supportive instructions will help ensure that you correctly document the vaccine administration for individuals in your care.

Follow the steps to complete the record effectively.

1. Press the ‘Get Form’ button to retrieve the Vaccine Administration Record and open it in your editor.
2. Begin by entering the patient's name, birthdate, and chart number at the top of the form.
3. For each vaccine administered, fill in the type of vaccine using either the generic abbreviation or the trade name. Refer to the provided table for options.
4. Indicate the date the vaccine was given in the format 'mo/day/yr'.
5. Record the funding source for the vaccine in the designated area, using 'F' for federal, 'S' for state, or 'P' for private.
6. Specify the route of administration ('IM', 'SC', 'ID', 'IN', 'PO') and the site of administration ('RA', 'LA', 'RT', 'LT').
7. Complete the Vaccine Information Statement (VIS) details by noting the lot number, manufacturer, and the date on the VIS.
8. Document the vaccinator's name and title, along with their signature or initials in the provided section.
9. If multiple doses or combination vaccines are given, repeat the relevant steps for each entry, ensuring accurate record-keeping.
10. Finally, after all necessary information is filled in, save your changes, download the form, or print it for sharing.

Complete your vaccine documentation online today to ensure accurate and reliable health records.