AGENCY: Davis County (Utah). Health Department. Nursing Division
SERIES: 10779
TITLE: Immunization informed consent card
DATES: 1970-2018.
ARRANGEMENT: Alphabetical by name
DESCRIPTION: These are forms filled out by parents before their children receive immunization for measles, mumps, rubella, polio, diphtheria, tetanus, and pertussis. Consent is secured to help protect the local department against suit for failure to obtain informed consent under UCA 78B-3-406 (1995). These forms include the patient's name, address, age, and date of birth; the signature of the consenting adult; and a printed description of the benefits and risks of the vaccine.
RETENTION
Retain for 7 year(s) or until date of birth
DISPOSITION
Destroy.
RETENTION AND DISPOSITION AUTHORIZATION
Retention and disposition for this series is proposed and has not yet been approved.
FORMAT MANAGEMENT
Paper: Retain in Office for 7 years after last visit and then destroy.
APPRAISAL
PRIMARY DESIGNATION
Private