Get Al Public Health Pediatric Immunization Record 2009-2025

Completing the AL Public Health Pediatric Immunization Record online is a straightforward process that ensures your child's vaccination history is accurately documented. This guide will walk you through each step of the form, making it easy to provide the necessary information.

Follow the steps to fill out the immunization record correctly.

1. Press the ‘Get Form’ button to access the immunization record and open it in an editable format.
2. Begin by entering the patient’s full name in the designated field at the top of the form, followed by their date of birth and record number. This information is crucial for identifying the child’s immunization history.
3. Fill in any allergies or reactions in the next section. Providing this information is vital for medical providers to ensure the safety of vaccinations.
4. Indicate if the child has a history of chickenpox by selecting 'YES' or 'NO', and specify the date if known. This information assists in determining the need for certain vaccines.
5. For each vaccine administered, complete the corresponding sections. Circle the correct vaccine from the list provided for each dosage. Enter the age at which the Vaccine Information Statement (VIS) was given, the manufacturer, lot number, and the administration date.
6. Document the route of administration, selecting either intramuscular (IM) or subcutaneous (SQ), along with the site of injection, specifying the left or right arm or thigh.
7. Check the Vaccines for Children (VFC) Program eligibility status based on the child's insurance status. Mark the appropriate box with a pencil and note the screening dates.
8. Complete any additional vaccine information in the sections provided. Be sure to fill in all relevant details for each vaccine received.
9. If applicable, record details from the tuberculin test, including the date administered, the type of test, and results.
10. Once all sections are complete, review the information for accuracy. You can then save changes, download, print, or share the completed immunization record as needed.

Ensure your child's immunization records are up-to-date by completing the form online today.