search    contact us
THE DANGER
THE VACCINE
THE PRIORITY
THE STRATEGY
adverse event info
education toolkit
resource center
my vaccination
smallpox overview

Last Updated:
19 Sep 14

header image

 RESOURCE CENTER: FORMS

    If you have clinical questions related to vaccination,
    please contact the DoD Vaccine Clinical Call Center at 1-866-210-6469.

   sitemap    home
title
seperator
  arrow What's New
seperator
  arrow Forms
seperator
  arrow Images 
seperator
  arrow Library
seperator
  arrow News
seperator
  arrow Policies
seperator
  arrow Q & A
seperator
  arrow Related Links
seperator
  arrow Service Messages
seperator
  arrow Smallpox Planning Docs
seperator
  arrow Supply & Logisics
seperator
  arrow Vaccine & VIG Info
seperator



 VAERS
   Vaccine Adverse Event Reporting System

 30-day Diary Card PDF  7 Feb 08
   Symptom Diary After Smallpox Vaccination

 Initial Competency Assessment: Smallpox Vaccine Administration PDF  7 Mar 08
   MILVAX Agency

 Initial Competency Assessment: Smallpox Vaccine Reconstitution PDF  7 Mar 08
   MILVAX Agency

 Smallpox Vaccine Screening Form PDF  5 Feb 14
   MILVAX-VHCN

 Smallpox Vaccine Screening or Medical Note Continuation Page PDF  7 Feb 08
   Smallpox Vaccination Continuation Note CHRONOLOGICAL RECORD OF MEDICAL CARE

 Smallpox Vaccine Sick Call Medical Note PDF  23 Jul 09
   Follow-Up Note for Sick Call Evaluation of Patients [pre position this form at ERs and troop medical clinics]

 Smallpox Vaccine Take Check Medical Note PDF  23 Jul 09
   Follow-Up Note for Standard "Take-Check" Visits

 VAERS Smallpox Pregnancy Supplement PDF  19 Jul 12
   Supplemental Form for Smallpox Vaccine in Pregnancy Registry