Child and Teen Immunization Screening Questionnaire
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Product number  R4060
Date published  February 2008
Description
Save valuable time and make sure that infants, children and teens are fully screened for vaccine contraindications by using these simple one page questionnaires of 11 questions. Patients or their caregivers respond to questions by checking "yes" and "no" boxes while waiting to be seen. Staff reviews patient answers during the visit.
 
Child and teen immunization screening questionnaires for vaccine contraindications are now available in convenient tear-off pads of 100 sheets of ivory paper. Each pad comes shrink-wrapped with 4 ivory cardstock health professional reference cards that list explanations and references for each contraindication.
Dimensions
8 1/2" x 11" pads of 100 patient forms and 4 cardstock health professional reference cards
Pricing
1 pad
$16.00 each
2   pads
$12.00 each
3   pads
$11.00 each
4-9   pads $10.00 each
10-24   pads $ 9.50 each
25-49   pads $ 9.00 each
50+   pads Please call.
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.
Immunization Action Coalition  |  1573 Selby Avenue  |  St. Paul MN 55104
contact: admin@immunize.org  |  www.immunize.org
tel: 651.647.9009  |  fax: 651.647.9131