Vaccine Administration Record for Children and Teens Vaccine Administration Record for Children and Teens - michigan 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the 'Clinic Name/Address' at the top of the form. This identifies where the vaccination is being administered.
3. Fill in the 'Patient Name' and 'Date of Birth' fields to ensure accurate record-keeping for each child or teen.
4. In the 'Vaccine' section, select the type of vaccine administered from the provided list. Be sure to note any additional vaccines given elsewhere by placing an asterisk next to the date.
5. Complete fields such as 'MCIR ID#', 'Date Vaccine Given', and details about the vaccine including 'Manufacturer', 'Lot Number', and administration site (e.g., left arm, right leg).
6. Indicate the route of administration (e.g., intramuscular, oral) using the provided codes.
7. Finally, have the vaccine administrator sign in the designated area to validate that vaccinations were properly administered.

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