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Vaccine Administration Record for Children and Teens 2026
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How to Use or Fill Out the Vaccine Administration Record Online
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- Click ‘Get Form’ to open the Vaccine Administration Record in our editor.
- Begin by entering the patient's name and birthdate at the top of the form. This information is crucial for accurate record-keeping.
- In the 'Type of Vaccine' section, select the appropriate vaccine from the provided list. Ensure you use either the standard abbreviation or trade name as indicated.
- Record the date when the vaccine was administered in the format (mo/day/yr). This helps maintain a clear timeline of vaccinations.
- Indicate the funding source for each vaccine given, using F for federal, S for state, or P for private.
- Document where the vaccine was administered by selecting from options like RA (right arm) or LA (left arm).
- Finally, ensure that a vaccinator's signature or initials and title are included to validate this record.
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printable immunization form
Vaccine Administration Record for Children and Teens (PDF); Vaccine Administration Record for Adults (PDF). Additional resources regarding vaccine documentationRead more
Need a copy of your or your childs immunization record? Fill out the linked form and submit to ImmTrac2@dshs.texas.gov or mail to the address in the ContactRead more