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Immunization Record Form shs.gmu.edu/immunizations Visit the website for office hours and more information. INSTRUCTIONS Completed immunization forms are due by August 1st for Fall/Summer and January
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Gather all necessary information before starting to fill out the form.
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Carefully read and follow the instructions provided on the form.
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Enter the individual's personal information accurately, including full name, date of birth, and contact information.
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Record the dates and types of vaccines received in the appropriate sections of the form.
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Ensure that the healthcare provider signs and dates the form to verify the accuracy of the information provided.

Who needs blank vaccine record forms?

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Individuals who have received vaccinations and need to keep a record of their immunization history.
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Healthcare providers who administer vaccines and need to document the vaccines given to patients.
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Blank vaccine record forms are documents used to record information about vaccines administered to individuals.
Healthcare providers and facilities are required to file blank vaccine record forms for each individual who receives a vaccine.
Blank vaccine record forms can be filled out by entering information such as the date of vaccination, type of vaccine administered, dosage, and recipient's information.
The purpose of blank vaccine record forms is to keep a record of vaccines administered to individuals for tracking and reference purposes.
Information such as the date of vaccination, type of vaccine administered, dosage, and recipient's information must be reported on blank vaccine record forms.
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