Product
number
R4065 |
|
| Date
published
April 2009 |
|
| Description |
|
| Save valuable
time and make sure that adults are fully screened for vaccine
precautions and contraindications by using these simple one-page
questionnaires of 10 questions. Patients respond to questions by
checking "yes" and "no" boxes while waiting to be seen. Staff reviews
patient answers during the visit. Included for no extra charge is the
Spanish version of the questionnaire printed on the back side of the
patient form.
Adult immunization screening questionnaires for vaccine precautions
and contraindications are available in convenient tear-off pads of 100
sheets of light gray paper. Each English/Spanish pad comes
shrink-wrapped with 4 light gray cardstock healthcare professional
reference cards (available in English only) that list explanations for
each of the 10 questions on the screening questionnaire. |
|
|
Specifications |
|
| 8 1/2" x 11"
pads of 100 two-sided opaque gray paper patient forms. Side one is in
English and side two is in Spanish. Designed to allow room for 2 or 3
hole punches on the top and sides of the patient form. Each pad of
forms is shrink-wrapped with 4 sturdy cardstock healthcare
professional reference cards printed in English on gray 110#
cardstock. |
|
| Pricing |
|
|
|
| For quotes on
larger quantities or customizing call 651-647-9009 or email
admininfo@immunize.org |
|
| Credits |
|
| Created and
distributed by the Immunization Action Coalition. |
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