Vaccination details Name of vaccine sticker if available Date of Pharmacy stamp vaccine/ vaccination* manufacturer* Batch Injection site* Left upper arm Number* Right upper arm Expiry Route of Intramuscular administration* Date* Subcutaneous Location (if not Patient’s home in the Long-stay care home or long-stay residential facility pharmacy)* Any adverse effects* Advice given and any other notes Administered Signature* GPhC number* by* (pharmacist name)
Vaccination details Name of vaccine/ manufacturer* vaccine sticker if available Date of vaccination* Pharmacy stamp Batch Number* Injection site* Left upper arm Right upper arm Expiry Date* Route of administration* Intramuscular Subcutaneous Location (if not in the pharmacy)* Patient’s home Long-stay care home or long-stay residential facility Any adverse effects* Advice given and any other notes Administered by* (pharmacist name) Signature* GPhC number*
Record-form-Word.docx