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Get the free Immunization for Pregnant Women: A Call to Action

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Household Composition Pregnant Conform HHCPECHOwide Cohort Version 01.20 / November 30, 2018Page 1 of 3COHORT IDS ITE PARTICIPANT IDPINCOHORT VISIT INFORM COMPLETED__ __ __ __ ____ __ __ _______ __
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How to fill out immunization for pregnant women

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How to fill out immunization for pregnant women

01
Obtain a copy of the immunization form for pregnant women from the healthcare provider.
02
Fill out personal information including name, date of birth, and contact information.
03
Provide information about your pregnancy including estimated due date and any complications.
04
Record any previous immunizations received during the current pregnancy.
05
List any allergies or medical conditions that may affect immunization.
06
Sign and date the form to certify that the information is accurate.

Who needs immunization for pregnant women?

01
Pregnant women who are recommended to receive immunizations to protect themselves and their babies from vaccine-preventable diseases.
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Immunization for pregnant women is the process of receiving vaccines to protect both the pregnant woman and her unborn baby from preventable diseases.
Healthcare providers who are providing prenatal care for pregnant women are required to file immunization records for pregnant women.
Immunization records for pregnant women can be filled out by healthcare providers and should include details of vaccines received, dates of immunization, and any adverse reactions.
The purpose of immunization for pregnant women is to protect both the mother and baby from diseases that can be harmful during pregnancy.
Information such as the type of vaccine, date of administration, lot number, and any adverse reactions should be reported on immunization records for pregnant women.
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