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Immunization Action Coalition
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Screening Questionnaires

Handouts: Clinic Resources

Screening Questionnaires

Administering Vaccines
Documenting Vaccination
Parent Handouts
Patient Schedules
Questions and Answers
Recommendations
Screening Questionnaires
Standing Orders
Storage and Handling
Supplies Checklist
Temperature Logs
Vaccine Reactions
Vaccine Summaries
Do I need any vaccinations today?
Three-page screening questionnaire for adult patients to find out about what shots they need [#P4036]
Screening checklist for contraindications to inactivated injectable influenza vaccination
Form your patients fill out to help you evaluate if influenza vaccine can be given at that day's visit, includes information sheet for professionals [#P4066]
Language:
SPANISH
HMONG
Screening checklist for contraindications to live attenuated intranasal influenza vaccination
Form your patients fill out to help you evaluate if influenza vaccine can be given at that day's visit, includes information sheet for professionals [#P4067]
Language:
SPANISH
HMONG
Screening checklist for contraindications to vaccines for adults
Form your patients fill out to help you evaluate which vaccines can be given at that day's visit, includes information sheet for professionals [#P4065]
Languages:
SPANISH
ARABIC
CHINESE
FRENCH
HMONG
KOREAN
RUSSIAN
TURKISH
VIETNAMESE
Screening checklist for contraindications to vaccines for children and teens
Form your patients fill out to help you evaluate which vaccines can be given at that day's visit, includes information sheet for professionals [#P4060]
Languages:
SPANISH
ARABIC
CHINESE
FRENCH
HMONG
KOREAN
RUSSIAN
TURKISH
VIETNAMESE
Should you be tested for hepatitis C? (for adults)
Use this questionnaire to assess your patients' risk factors [#P2192]
Should you be vaccinated against hepatitis A? (for adults)
Use this questionnaire to assess your patients' risk factors [#P2190]
Language:
SPANISH
Should you be vaccinated against hepatitis B? (for adults)
Use this questionnaire to assess your patients' risk factors [#P2191]
Language:
SPANISH
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This page was reviewed on June 17, 2014
 
Immunization Action Coalition  •  Saint Paul, MN
tel 651-647-9009  •  fax 651-647-9131
 
This website is supported in part by a cooperative agreement from the National Center for Immunization and Respiratory Diseases (Grant No. 5U38IP000290) at the Centers for Disease Control and Prevention (CDC) in Atlanta, GA. The website content is the sole responsibility of IAC and does not necessarily represent the official views of CDC.