IWeb
User Guide
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Immunization Record Consent (Washington)
This report is used to display a specific patient's immunization record, but only for vaccines administered on the current day, with a consent form (with signature line) at the bottom that can be edited by the Organization (IRMS). The report displays the Dose Number, Vaccination Date, Patient Age, Manufacturer, Clinic, Lot Number, Dose Volume, VIS Date, Supply Source, Name of the person and their suffix that administered the vaccine, comments (if any), PPD reading (if entered), and all contraindications. Search for the patient before running this report.
Run the Report
To run this report, search for the patient and then click the Reports > State Reports > Patient Specific > Immunization Record Consent link. The Immunization Record Consent page opens with the patient's name and the consent message already populated. Edit the information if necessary and click Create Report. (If you make changes and want to revert back to the original text, click Revert to Default.) The report displays for that patient in a new browser tab. To print the form, use the browser's print function.
Example Report
The following image is of an example Immunication Record Consent form. Note that reports may differ in format and headings depending on settings.
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