Documentation

Screening Questions 1. 1.Is your child sick today? 2. 2.Does your child have allergies to medications, food, or any vaccine? 3. 3.Has the child had a serious reaction to a vaccine in the past? 4. 4.Has the child had a seizure or a brain problem? 5. 5.Does your child have cancer, leukemia, AIDS or any other immune system problem?

Screening Questions 6. 6.Has the child received a transfusion of blood or blood products, or been given a medicine called immune (gamma) globulin in the past year? 7. 7.Has your child taken cortisone, prednisone, other steroids or anticancer drugs or had x-ray treatments in the past 3 months? 8. 8.Is the child/teen pregnant or is there a chance she could become pregnant during the next month Has the child received any vaccinations in the past 4 weeks? Did you bring your child’s immunization record with you?

Documentation Requirements Federal requirements for vaccine documentation: Type of vaccine Date given Route Manufacturer Lot number Administration Site Vaccine Information Statement publication date Name and title of person administering vaccine Office name, address, and phone number Any exemptions must be documented in the patients chart

Documentation Requirements VFC screening is required for state supplied vaccine Includes screening for Medicaid, Alaska Native, American Indian, no health insurance, or underinsured Patient screening questions also need to be documented at each visit If parent does not want their children immunized, have them sign an exemption form which is located on the IRIS main page

Clinic History Forms

Exemption Documentation Have the parent sign the exemption form for every separate antigen that the child will not be immunized for.

Nurses Station Worksheet Document all doses given on the nurses worksheet, including wasted doses