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IMMUNIZATION CONTRAINDICATION CHECKLIST MUST BE COMPLETED EACH TIME A CLIENT RECEIVES SHOTS NAME ______________________________________________________ AGE: _____________ 1. Is client sick with illness other than a cold?
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Document Date: 2005-12-20 12:50:44

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MedicalCondition

fever / leukemia / TB / lymphoma / disease / AIDS / infection / hives / shock / illness / infections / Varicella / anaphylactic allergic reaction / severe itching rash / /

MedicalTreatment

IMMUNIZATION / chemotherapy / immunizations / radiation / /

Position

Left Deltoid RT / Administrator / Nurse / /

Product

prednisone / /

ProvinceOrState

Illinois / /

Technology

radiation / chemotherapy / /

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