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Child immunization record printable 2025

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The document is a Vaccine Administration Record for Children and Teens, detailing the process for administering vaccines, including necessary information such as patient details, vaccine types, administration dates, funding sources, and site of administration. It emphasizes the importance of providing Vaccine Information Statements (VISs) to parents or legal representatives before vaccination and includes instructions on how to complete the record accurately.

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Click ‘Get Form’ to open the child immunization 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.
For each vaccine administered, fill in the type of vaccine, date given (in mm/dd/yyyy format), funding source (F for federal, S for state, P for private), and site of administration (e.g., RA for right arm).
Record the vaccine lot number and manufacturer details as specified. Ensure you also note the publication date of each Vaccine Information Statement (VIS) provided to the parent.
Finally, have the vaccinator sign or initial and include their title to validate the record. Repeat these steps for any additional vaccines listed on page two.

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Versions	Form popularity	Fillable & printable
2023	4.3 Satisfied (25 Votes)
2016	4.8 Satisfied (61 Votes)
2014	4.6 Satisfied (63 Votes)
2011	4.4 Satisfied (360 Votes)
2008	4.2 Satisfied (70 Votes)

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Can you download documents from mychart?

When you download your health or visit summary documents, several files are compressed into a single ZIP file so they can be transferred quickly. You need to uncompress (unzip) this file before you can view your documents.

What is the quickest way to get immunization records?

How to Contact Your Jurisdictions IIS contact the IIS in your state or in the state where you or your child received their last shots to see if they have records. contact your immunization provider directly or your local or state immunization program through your states health department.

Can I get a copy of my immunization records online on mychart?

Go to My Record Health Summary and select the Immunizations tab. You can see the immunizations youve received and the dates on which you received them. Click the immunization name to learn more. If your immunizations are not up to date, please docHub out to your clinic directly to have your information updated.

How to obtain your childs immunization records?

You can request a copy from the school nurse or administration. State Immunization Registry: Many states have immunization registries where vaccination records are maintained. You can check with your states health department or visit their website for information on how to access these records.

Does NYS have an immunization registry?

The New York State Immunization Information System (NYSIIS) is an electronic registry that maintains immunization records for New York State children and adults.

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How do I know if I was vaccinated as a child?

Looking for Your Immunization Record? Visit the Digital Vaccine Record portal to download a copy of your immunization record from CAIR.