Fillable Immunisation Register for Early Childhood Services and Primary (Health Promotion Agency New Zealand)

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Immunisation Register for Early Childhood Services and Primary (Health Promotion Agency New Zealand)

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The Immunisation Register for Early Childhood Services and Primary (Health Promotion Agency New Zealand) form is 2 pages long and contains:

  • 0 signatures
  • 390 check-boxes
  • 212 other fields

Country of origin: NEW-ZEALAND
File type: PDF

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Immunisation
Register
for Early Childhood Services and Primary Schools
School Class
Immunisation Register for Early Childhood Services and Primary Schools
The information on this register is to come from the child’s Immunisation Certifi cate. The child’s parent/guardian has the right to view their child’s information. Any errors must be corrected. This register must be kept in a secure place, and the information kept confi dential.
The register may be used to identify unimmunised children during an outbreak.
This resource is available from www.healthed.govt.nz or the Authorised Provider at your local DHB. Revised May 2017. 06/2017. Code HE1111
Date Child’s Name Birthdate
If child is less than
15 months old, date
when certifi cate is
next to be shown
Certifi cate not shown
Immunisation complete
Pneumococcal
Rubella
Mumps
Measles
Hib
Pertussis
Tetanus
Diphtheria
Polio
Hepatitis B
Rotavirus
Immunisation incomplete
If incomplete, tick diseases
immunised/natural immunity
Chickenpox (varicella )
Comments
Immunisation
Register
for Early Childhood Services and Primary Schools
School Class
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Immunisation Register for Early Childhood Services and Primary (Health Promotion Agency New Zealand)

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Completed 29 July 2020

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