| Product
number R4060 |
 |
| Date
published
April 2009 |
|
| Description |
|
|
Save valuable time and make sure that infants, children, and teens are
fully screened for vaccine precautions and 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. Included for no extra charge is the Spanish version of the
questionnaire printed on the back side of the patient form.
Child and teen immunization screening questionnaires for vaccine
precautions and contraindications are available in convenient tear-off
pads of 100 sheets of ivory paper. Each English/Spanish pad comes
shrink-wrapped with 4 ivory cardstock healthcare professional
reference cards (available in English only) that list explanations for
each of the 11 questions on the screening questionnaire. |
|
|
Specifications |
|
| 8
1/2" x 11" pads of 100 two-sided opaque ivory 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 ivory 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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