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THE DANGER
THE VACCINE
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Last Updated:
13 Aug 09
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 RESOURCE CENTER: FORMS

    If you have clinical questions related to vaccination,
    please contact the DoD Vaccine Clinical Call Center at 1-866-210-6469.

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 VAERS Form
   

 30-day Diary Card PDF  7 Feb 08
   Symptom Diary After Smallpox Vaccination

 Continuation Page PDF  7 Feb 08
   Smallpox Vaccination Continuation Note CHRONOLOGICAL RECORD OF MEDICAL CARE

 Initial Competency Assessment: Smallpox Vaccine Administration PDF  7 Mar 08
   MILVAX Agency

 Initial Competency Assessment: Smallpox Vaccine Reconstitution PDF  7 Mar 08
   MILVAX Agency

 Medical Note for Follow-Up after Vaccination  PDF  23 Jul 08
   Follow-Up Note for Standard "Take-Check" Visits

 Medical Note for Follow-Up after Vaccination  PDF  23 Jul 08
   Follow-Up Note for Sick Call Evaluation of Patients [pre position this form at ERs and troop medical clinics]

 Medical Note for Screening for Contraindications  PDF  7 Apr 08
   2-page format, STANDARD FORMAT

 VAERS Pregnancy Supplement PDF  1 Mar 08
   Supplemental Form for Smallpox Vaccine in Pregnancy Registry