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VACCINE ADMINISTRATION RECORD for TetanusDiphtheria/Trap, HPV and/or Meningococcal Vaccines The doctor or clinic may keep this record in your medical file or your children medical file. They will
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01
First, obtain a vaccine information statement (VIS) for the specific vaccine that needs to be filled out.
02
Read through the VIS carefully and gather all necessary information.
03
Start by providing the patient's name, date of birth, and contact information in the designated fields.
04
Next, enter the vaccine administration date and location.
05
Fill in the vaccine manufacturer, lot number, and expiration date.
06
Specify the vaccine dosage and route of administration.
07
Indicate any adverse reactions or side effects experienced by the patient, if applicable.
08
Include the healthcare provider's name, signature, and contact information.
09
Double-check all entered information for accuracy and completeness.
10
Finally, submit the filled-out vaccine information statement to the appropriate healthcare authority or organization.

Who needs vaccine information statement vaccine?

01
Any individual who has received or will receive a vaccine should be provided with a vaccine information statement.
02
This includes both children and adults, regardless of age or medical history.
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It is essential to provide this information to ensure informed consent and enable individuals to make informed decisions regarding their healthcare.
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A Vaccine Information Statement (VIS) is a document created by the Centers for Disease Control and Prevention (CDC) that provides information about the benefits and risks of a vaccine. It is intended to ensure that patients and guardians receive adequate information regarding vaccines.
Healthcare providers who administer vaccines are required to provide Vaccine Information Statements to patients or their guardians before vaccination.
To fill out a Vaccine Information Statement, healthcare providers must complete the VIS by providing accurate information about the vaccine to be administered, including details about the disease it prevents, potential side effects, and the recommended schedule.
The purpose of a Vaccine Information Statement is to inform patients and caregivers about the vaccine, ensuring they understand the benefits, risks, and what to expect, thus promoting informed consent.
The information that must be reported includes the name of the vaccine, the date it was given, the manufacturer's name, the lot number, and the signature of the person administering the vaccine.
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