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Tdap sample 2026
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- Click ‘Get Form’ to open the tdap sample in the editor.
- Begin by filling in the name of the person receiving the vaccine. Ensure you include their last name, first name, and middle initial.
- Next, enter the birthdate in the format mm/dd/yy and select their sex by circling either M or F.
- Complete the address section with street, city, county, state (TX), and zip code.
- In the 'Vaccine to be given' section, confirm that 'Tetanus and Diphtheria (Td) Vaccine' is selected.
- Provide your signature as the person receiving the vaccine or as an authorized individual (parent/guardian) along with the date.
- Finally, ensure that a witness signs and dates where indicated, along with the signature of the vaccine administrator and their title.
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Related links
The Tdap vaccine protects teens against tetanus, diphtheria, and pertussis (whooping cough). The vaccine is recommended for all children 11 years and older.Read more
Tdap. 40y 1m. Next Due. DUE NOW. INFLUENZA. DUE NOW. HEP B ADULT. =20 YRS. Not recommended after 8 months. 05/06/2020. TD (= 7. YRS.) Not generally.Read more