Vaccination Record-keeping Essentials

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Vaccination Record-keeping Essentials Do you
have all of the tools you need?

• Diane C. Peterson and Deborah L. Wexler, MD
• Immunization Action Coalition
• National Immunization Conference
• May 11-14, 2004

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Tip 1 Maintain a comprehensive vaccine
administration record for each patient

• Consider using prototypes from IAC
• Vaccine Administration Record for Children
  Teens1
• Vaccine Administration Record for Adults2
• Include all federally-required items
• manufacturer lot number
• date of publication of the VIS date given to
  the vaccinee
• name, address, title of person administering
  vaccine
• Flag those records that indicate the patient is
  behind or due for additional immunizations
  (vaccinate at their next visit!).

1For a copy, go to www.immunize.org/catg.d/p2022b
.pdf
2For a copy, go to www.immunize.org/catg.d/p2023b
.pdf
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Tip 2 Use generic abbreviations when recording
the type of vaccine given

• Single products
• DTaP, DT, Td, TT
• HepA, HepB
• Hib
• IPV
• PCV, PPV
• MMR
• TIV, LAIV

• Combination Products
• Hib-HepB
• DTaP-HepB-IPV
• DTaP-Hib
• HepA-HepB

Whats Tetramune?
Hint Do not use trade names!
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Tip 3 Record information on vaccinations given
by other providers, including those from foreign
countries

• Copy information from the patients personal
  immunization record or from records sent from
  other clinics onto the patients vaccine
  administration record.
• Use resources to translate foreign terms and
  products such as IACs
• Vaccines and Biologics Used in U.S. and Foreign
  Markets3
• Translation of Vaccine-Related Terms Into
  English4
• Quick Chart of Vaccine-Preventable Disease Terms
  in Multiple Languages5

Whats ????? (Answer DTP in Russian)
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Tip 4 Record other vaccinations and/or
biologics that may impact future vaccinations

• Other vaccines
• Bacille Calmette-Guerin
• meningogoccal
• Japanese encephalitis
• rabies
• typhoid, live
• typhoid, inactivated
• yellow fever

• Other biologics
• hepatitis A immune globulin
• hepatitis B immune globulin
• rabies immune globulin
• tetanus immune globulin
• tuberculin skin test
• varicella zoster immune globulin

Hint Record these other vaccinations and/or
biologics under the other section of the
vaccine administration record.
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Tip 5 Share information with other providers,
including regional/state automated registries

• Notify the patients primary provider (e.g.,
  particularly important if shots given in school,
  health dept, WIC).
• Develop a standard notification letter, such as
  IACs Prototype of Notification of Vaccination
  Letter6
• Provide a copy of the patients vaccine
  administration record to any clinic to which the
  patient transfers (avoid having to later pull
  record!).

6For a copy, go to www.immunize.org/catg.d/p3060n
ot.pdf
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Tip 6 Provide and update the patients personal
immunization record

• Regardless of your clinics participation in
  automated immunization registries, its a good
  idea to provide a paper copy of vaccinations
  given to your patients (in addition to the
  Vaccine Information Statement).
• Need a patient record card?
• Contact your local or state health department
• Contact you local professional society
• Consider the Adult Immunization Record7 card
  developed by IAC

7For a copy, go to www.immunize.org/adultizcards/
index.htm