Adult Immunization Record Card - Free Download
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(mo.) (day) (yr.)
Printed by Immunization Action Coalition • www.immunize.org
ADULT IMMUNIZATION RECORD
Always carry this record with you and have your
health professional or clinic keep it up to date.
Last name First name M.I.
Dose Type of Date given Health professional Date next
(units) vaccine mo/day/yr or clinic dose due
Hep B 1
Hep A 1
Combination vaccines should always be documented under each antigen.
A second dose may be
needed in some people