Get CA IMM-1053 2019
DAILY USAGE LOG VACCINES FOR CHILDREN VFC PROGRAM Date Ordering Period // to // INSTRUCTIONS Keep this log where you store vaccines. Always file your Usage Logs for reference. Frozen DTaP Patient Name or medical record Date of Infanrix DaptaBirth cel DTaPDTaPHepBIPV IPV Pediarix DTaPIPV/Hib HepA HepB Hib VAQTA Havrix RecomActHIB bivax PedvaxEngerix B HIB HibMenCY HPV Menhibrix IPOL MCV4 MenB PCV13 Menveo Prevnar Trumenba PPSV23 RV Td Pneumovax Tenivac Tdap MMR MMR-II VAR ProQuad Varivax a Daily Total Total Log taken by PAGE OF California Department of Public Health Immunization Branch IMM-1053 11/16. Fill in today s date patient info make a check for each vaccine you use. At the end of the day add up the checks. This is your Daily Total* When you prepare to order vaccines add up the Daily Totals. Report this as the number of doses administered during the ordering period. Fill in today s date patient info make a check for each vaccine you use. At the end of the day add up the checks. This is your Daily Total* When you prepare to order vaccines add up the Daily Totals. Report this as the number of doses administered during the ordering period..
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