Immunisation Form Received

Select if your organisation's immunisation form has been returned for the community member.

Enter the date received.

Form Status

Specify the status of the immunisation form. For example, indicate whether the form has been received, checked or processed.

The form status is maintained in the luImmunisationFormStatus lookup table. See Maintaining lookup tables in the System maintenance manual.

DTP

Select if the person received a Diphtheria, Tetanus, Pertussis (whooping cough) triple immunisation. Enter the date immunised.

Note: The corresponding Diphtheria, Tetanus and Whooping Cough fields are selected.

ADT

Select if the person received combined Diphtheria -Tetanus (Td) immunisation. Enter the date immunised.

Note: The Td formulation for adults is often referred to by the trade name ADT.

dTpa

Select if the person received a Diphtheria, Tetanus, Pertussis (whooping cough) triple immunisation. Enter the date immunised.

Note: The corresponding Diphtheria, Tetanus and Whooping Cough fields are selected.

Diptheria

Select if the person received a Diphtheria immunisation. Enter the date immunised.

Tetanus

Select if the person received a Tetanus immunisation. Enter the date immunised.

Whooping Cough

Select if the person received a Pertussis (whooping cough) immunisation. Enter the date immunised.

MMR

Select if the person received a Measles, Mumps, Rubella triple immunisation. Enter the date immunised.

Note: The corresponding Measles, Mumps and Rubella fields are selected.

Measles

Select if the person received a Measles immunisation. Enter the date immunised.

Mumps

Select if the person received a Mumps immunisation. Enter the date immunised.

Rubella

Select if the person received a Rubella immunisation. Enter the date immunised.

TWINRIX

Select if the person received a Hepatitis A and B double immunisation. Enter the date immunised.

Note: The corresponding Hepatitis A and B fields are selected.

TWINRX Adult

Select if the person received a Hepatitis A and B adult double immunisation. Enter the date immunised.

Note: The corresponding Hepatitis A and B adult fields are selected.

Hepatitis A

Select if the person received a Hepatitis A immunisation. Enter the date immunised.

Hepatitis A Adult

Select if the person received a Hepatitis A adult immunisation. Enter the date immunised.

Hepatitis B

Select if the person received a Hepatitis B immunisation. Enter the date immunised.

Hepatitis B Adult

Select if the person received a Hepatitis B adult immunisation. Enter the date immunised.

Hepatitis B Booster

Select if the person received a Hepatitis B booster immunisation. Enter the date immunised.

HIB

Select if the person received a Haemophilus influenzae serotype b immunisation. Enter the date immunised.

Influenza

Select if the person received an Influenza immunisation. Enter the date immunised.

Swine Flu

Select if the person received a Swine Flu immunisation. Enter the date immunised.

Poliomyelitis

Select if the person received a Poliomyelitis immunisation. Enter the date immunised.

Meningococcal C

Select if the person received a Meningococcal C immunisation. Enter the date immunised.

MeNZBTM

Select if the person received a MeNZB vaccine. This is a vaccine for a specific strain of group B meningococcus, used to control an epidemic of meningococcal disease in New Zealand until 2008.

4vMenPV

Select if the person received a 4vMenPV vaccine. This is a short term vaccine the A, C, W135 and Y groups of meningococcus. Enter the date immunised.

Chicken Pox

Select if the person received a Chicken Pox immunisation. Enter the date immunised.

Tuberculosis

Select if the person received a Tuberculosis immunisation. Enter the date immunised.

Cholera

Select if the person received a Cholera immunisation. Enter the date immunised.

Vivaxim

Select if the person received a Hepatitis A and typhoid double vaccination. Enter the date immunised.

Typhoid

Select if the person received a Typhoid immunisation. Enter the date immunised.

Japanese Encephalitis

Select if the person received a Japanese Encephalitis immunisation. Enter the date immunised.

Yellow Fever

Select if the person received a Yellow Fever immunisation. Enter the date immunised.

Meningitis

Select if the person received a Meningitis immunisation. Enter the date immunised.

Pneumococcal

Select if the person received a Pneumococcus immunisation. Enter the date immunised.

HPV

Select if the person received an immunisation for the Human Papilloma Virus. Enter the date immunised.

Rabies

Select if the person received a Rabies immunisation. Enter the date immunised.

Custom immunisation

Select if the person received an immunisation determined by your organisation. Enter the date immunised.

Note: These immunisations are controlled by configuration settings. See CustomImmunisation configuration setting in the System maintenance manual.

Immunisation Details

Type any other details about the person's immunisation.