Get Mn Mdh 140-0498 2013-2025

Filling out the MN MDH 140-0498 form, known as the Pediatric Immunization Record, is essential for keeping accurate immunization data. This guide provides a clear and organized approach to completing the form online, ensuring that all required fields are accurately filled out.

Follow the steps to complete the MN MDH 140-0498 form online

1. Click the ‘Get Form’ button to access the document, allowing you to begin the process of filling out the required information.
2. Enter the patient's last name and first name in the designated fields to clearly identify the individual whose immunization record is being documented.
3. Provide the date of birth in the format MM/DD/YYYY, ensuring accuracy as this will help verify the patient's age and immunization schedule.
4. Fill in the mother’s maiden name in the corresponding field if required, as this may assist in accurately identifying the patient.
5. Record each vaccine administered by filling in details such as the vaccine name (e.g., diphtheria, tetanus, pertussis) in the vaccine field.
6. Indicate the date each vaccine was given, using the format MM/DD/YYYY, to maintain an accurate immunization timeline.
7. Select the type of vaccine received, referencing the manufacturer's code from the provided list to ensure correct recording.
8. Fill in the lot number for each vaccine given, which is crucial for tracking batches in case of vaccine-related issues.
9. Specify the administration route (e.g., IM for intramuscular, SC for subcutaneous) and the site of the injection, indicating which limb and side was used.
10. Complete the information regarding the dosage given and ensure that the vaccine administrator’s signature and title are recorded accurately.
11. If applicable, mark the history of vaccine reactions for the patient and note if vaccines were given elsewhere on the form.
12. Once all sections are completed, review the data for accuracy, then save your changes and download or print the form for distribution to the appropriate parties.

Start completing your MN MDH 140-0498 form online today to ensure accurate immunization records!