Immunization Record Excel Template

Immunization Record

 

Name

Date of Birth

Medical Notes

Vaccine	Date	Administered by	Location	Next Dosage	Reaction Notes
Hepatitis B
Diphtheria, Tetanus, Pertussis
H. Influenza type b
Inactivated Poliovirus
Pneumococcal
Measles, Mumps, Rubella
Varicella (Chickenpox)
Hepatitis A
Rotavirus
Human Papillomavirus
Influenza (yearly vaccine)
Other Vaccines

Notes on Immunization Record Example

Use this Immunization Record to keep track of yours or your child's immunizations.

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