Adult Immunisation Record

Who this is for

Your own copy of what you have been given and when. Each line records the date, what was given, where and by whom, the batch number if you were given one, and the next date you were advised — all of it copied from the card, letter or receipt you were handed at the time.

Adults whose immunisation history is spread across a practice, a pharmacy, an occupational health department and a travel clinic, people changing practice or country, and anyone asked to show what they have had.

What this helps you track

• What was given and when, in one list instead of four
• Where it was given and by whom, when several places are involved
• Batch numbers, where the card or receipt shows one
• The next date you were advised, written in the words you were given
• Which certificates and cards you hold, and where they are kept

How to use it

1. Fill in your details and your practice at the top of the sheet.
2. Copy each entry from the card, letter, app or receipt you were given — the date, what it was called and where you had it.
3. Add the batch number when there is one on the paperwork; some employers and travel schemes ask for it.
4. Write the next date only if you were given one, and note who gave it to you.
5. Record the certificates and cards you hold in the lower table, with where each one is kept.
6. Keep the sheet with your documents, or fill it in online and save it in your own browser.

Formats

• Printable PDF (A4 and US Letter)
• Fillable PDF with form fields
• Fill in online, saved in your browser

The printable is laid out inside a box that fits both A4 and US Letter, so the two files are identical and neither one is scaled. The fillable PDF has real form fields. The online version keeps what you enter in your own browser and builds the completed PDF on your device.

How to print

Download the A4 or US Letter file to match the paper in your printer, open it in a PDF reader and print at 100% — not "fit to page", which shrinks the writing space. Both files leave a 14 mm margin, which clears the unprintable edge on home printers. To print the online version with your entries in it, use the Print this sheet button, which prints only the sheet and none of the page around it. More on printing.

Questions

Does the sheet tell me what I am due?

No. It carries no schedule, no interval and no list of what any adult has or has not had. The next date column is for a date you were actually given by a clinician, copied across.

Is this proof of immunisation?

No. It is your own record. Anyone asking for proof will usually want the official card, certificate or record from whoever gave it, and this sheet helps you keep track of what you hold and where it is.

What if my history is incomplete?

Write what you can evidence and leave the rest blank rather than guessing. A partial record with dates you can support is more useful to a clinician than a complete one built from memory.

Why record where it was given?

Because adult immunisations are given in several places, and when you need a copy years later you have to know which of them to ask. The place and the date together usually find the record.