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