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Patient name: Date of birth: (mo.) (yr.) (day) Screening Checklist for Contraindications to Vaccines for Adults For patients: The following questions will help us determine which vaccines you may
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Read through the screening checklist for contraindications to familiarize yourself with the different sections and questions.
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Start at the top of the checklist and go through each item one by one.
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For each item, carefully review the instructions and criteria provided.
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If the criteria for a particular item are met, check the corresponding box or mark it as positive.
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Continue this process until you have reviewed and filled out all the items on the screening checklist.
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If you have any doubts or uncertainties, consult with the appropriate medical professional or supervisor.
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Who needs screening checklist for contraindications?

01
Healthcare professionals
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Medical practitioners
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Nurses
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Clinical staff
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Therapists
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Any individual involved in assessing patient eligibility for certain treatments or procedures
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The screening checklist for contraindications is a document used to identify any pre-existing medical conditions or risk factors that may prevent a certain treatment or procedure from being carried out.
Medical professionals, including doctors, nurses, and other healthcare providers, are required to file screening checklists for contraindications.
The screening checklist should be filled out by the healthcare provider, and it should list any relevant medical information about the patient that may impact their treatment.
The purpose of the screening checklist is to ensure that patients are properly assessed for any potential risks before undergoing a treatment or procedure.
The screening checklist should include information about the patient's medical history, current medications, allergies, and any known medical conditions.
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