Forms
Smallpox
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Smallpox
VAERS Smallpox Pregnancy Supplement PDF 19 Jul 12
Supplemental Form for Smallpox Vaccine in Pregnancy Registry
Smallpox Vaccine Screening Form PDF 08 Jan 10
2-page format, STANDARD FORMAT
Smallpox Vaccine Sick Call Medical Note PDF 23 Jul 09
Follow-Up Note for Sick Call Evaluation of Patients [pre position this form at ERs and troop medical clinics]
Smallpox Vaccine Take Check Medical Note PDF 23 Jul 09
Follow-Up Note for Standard "Take-Check" Visits
Initial Competency Assessment: Smallpox Vaccine Reconstitution PDF 07 Mar 08
MILVAX Agency
Initial Competency Assessment: Smallpox Vaccine Administration PDF 07 Mar 08
MILVAX Agency
30-day Diary Card PDF 07 Feb 08
Symptom Diary After Smallpox Vaccination
Smallpox Vaccine Screening or Medical Note Continuation Page PDF 07 Feb 08
Smallpox Vaccination Continuation Note CHRONOLOGICAL RECORD OF MEDICAL CARE
VAERS 09 Jan 06
Vaccine Adverse Event Reporting System