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    Declaration Back

    Uploaded by

    Jessa Mae
    This document contains vital sign screening forms for pre-vaccination and post-vaccination. The forms include fields for temperature, weight, blood pressure, pulse rate, respiratory rate, and blood oxygen saturation levels. There is also a declaration section where the recipient of the vaccination signs and dates to confirm that the vital sign data provided is true and accurate.

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    Declaration Back

    Uploaded by

    Jessa Mae
    5 views1 page
    This document contains vital sign screening forms for pre-vaccination and post-vaccination. The forms include fields for temperature, weight, blood pressure, pulse rate, respiratory rate, and blood oxygen saturation levels. There is also a declaration section where the recipient of the vaccination signs and dates to confirm that the vital sign data provided is true and accurate.

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    declaration back

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    This document contains vital sign screening forms for pre-vaccination and post-vaccination. The forms include fields for temperature, weight, blood pressure, pulse rate, respiratory rate, and blood oxygen saturation levels. There is also a declaration section where the recipient of the vaccination signs and dates to confirm that the vital sign data provided is true and accurate.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    5 views1 page

    Declaration Back

    Uploaded by

    Jessa Mae
    This document contains vital sign screening forms for pre-vaccination and post-vaccination. The forms include fields for temperature, weight, blood pressure, pulse rate, respiratory rate, and blood oxygen saturation levels. There is also a declaration section where the recipient of the vaccination signs and dates to confirm that the vital sign data provided is true and accurate.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    of 1

    VITAL SIGNS: VITAL SIGNS:

    SCREENING POST-VACCINATION VITAL SIGNS: VITAL SIGNS:


    SCREENING POST-
    Temperature: ______ Temperature: ______ VACCINATION
    Temperature:_______
    Weight:____________ Weight:____________
    BP:________________ Weight:____________ Temperature: ______
    BP:________________
    PR:________________ PR:________________ BP:________________ Weight:____________
    RR:________________ RR:________________ PR:________________ BP:________________
    SpO2:______________ SpO2:______________ RR:________________ PR:________________
    SpO2:______________ RR:_______________
    SpO2:______________

    Declaration:
    I hereby declare that the data/s furnished in this declaration Declaration:
    screening form are true and correct to the best of my knowledge
    and belief and I undertake the responsibility to inform you of any I hereby declare that the data/s furnished in this declaration
    charges therein, immediately. screening form are true and correct to the best of my knowledge
    and belief and I undertake the responsibility to inform you of any
    charges therein, immediately.

    Name & Signature of Recipient of the Vaccination


    Date:_______________
    Time:_______________ Name & Signature of Recipient of the Vaccination
    Date:_______________
    Time:_______________

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