COVID-19 Vaccination Record Card
Please keep this record card, which includes medical information about the vaccines you have received.
Last Name First Name
Date of birth Patient number (medical record or IIS record number)
Vaccine
|
ProductName/Manufacterer
Lot Number
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Date
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Healthcare Professional or Clinic Site
|
|
1st Dose COVID-19
|
|
…./…./……
|
|
2nd Dose COVID-19
|
|
…./…./……
|
|
Other
|
|
…./…./……
|
|
Other
|
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…./…./……
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Chia sẻ với bạn bè của bạn: | 
