Keeping track of your immunizations as an adult is an important self-care step that can prevent a lot of confusion in the future. Click on the printer icon at the top of the page to make a copy. Fill out with pen and keep with your other health records.
| Immunization Type | Date(s) |
| Influenza(Usually given to people over 65 years of age or to people with chronic asthma or chronic obstructive pulmonary disease.)
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| Tetanus and Diptheria (Td)(Usually given every 10 years.) | |
| Pneumococcal(Usually given to prevent pneumonia in certain patients at risk.) | __Yes __No __Need revaccination?If so, reason: |
| Meningococcal(Usually given to prevent meningitis in certain patients at high risk.) | __Yes __NoReason: |
| Hepatitis B | __Yes __NoReason: |
| Others |
