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Immunization record 2025

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The document is a Vaccine Administration Record for Adults, detailing the process and requirements for administering vaccines. It includes sections for patient information, vaccine types, administration dates, funding sources, routes of administration, and details about the vaccines provided. The document emphasizes the importance of providing Vaccine Information Statements (VISs) to patients and ensuring they understand the risks and benefits of vaccinations.

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Click ‘Get Form’ to open the immunization record in the 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 'Vaccine' section, select the type of vaccine administered from the provided list. Ensure you accurately note whether it’s Tdap, Hepatitis A, or any other vaccine.
Record the date when each vaccine was given in the format (mo/day/yr). This helps track vaccination schedules effectively.
Indicate the funding source for each vaccine using F (federal), S (state), or P (private) as applicable.
Document the route and site of administration, such as IM for intramuscular or SC for subcutaneous, along with specific locations like RA (right arm) or LA (left arm).
Finally, ensure that a vaccinator's signature or initials and title are included to validate the record.

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See more immunization record versions

We've got more versions of the immunization record form. Select the right immunization record version from the list and start editing it straight away!

Versions	Form popularity	Fillable & printable
2023	4.1 Satisfied (43 Votes)
2018	4.8 Satisfied (36 Votes)
2016	4.3 Satisfied (201 Votes)
2014	4 Satisfied (59 Votes)
2011	4 Satisfied (20 Votes)
2008	4.9 Satisfied (38 Votes)
2003	4 Satisfied (37 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.

How long do schools keep immunization records?

Check with your high school and/or college health services for dates of any immunizations. Keep in mind that generally records are kept only for 1-2 years after students leave the system. Check with previous employers (including the military) that may have required immunizations.

What is the immunization information system?

Immunization information systems (IIS) are confidential, population-based, computerized databases that record all immunization doses administered by participating providers to persons residing within a given geopolitical area.

What are your immunization records?

Vaccination records (sometimes called immunization records) provide a history of all the vaccines you or your child received. This record may be required for certain jobs, travel abroad, or school registration.

How do I get a copy of my immunization records in Alabama?

If you need your immunization record or Certificate of Immunization (COI), please contact the provider or county health department that administered your vaccines. You can also ask your current provider if they have access to Alabamas immunization registry, ImmPRINT, to locate your record.

What is the statute related to school immunizations in Kansas?

Kansas Statute Contained in KSA 72-6262 et seq., Kansas law requires proof of vaccination for all students enrolling for the first time in a school(1), preschool, day care program operated by a school, or as designated by the Secretary.

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Can I get a copy of my immunization records online in Kansas?

My Kansas Health Patient Portal - This option is only available to individuals with access to a computer. This option will allow an individual to access their immunization records any time after the initial setup of the account.

How do I get a copy of my immunization records in Kansas?

How to Request an Immunization Record Fax: 785-559-4227. Email. Mail: Kansas Department of Health and Environment. Attn: Kansas Immunization Registry. 1000 SW Jackson. Suite 210. Topeka, KS 66612.