Health Centre/Clinic/Hospital Routine Immunization Tally Sheet - PDF
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Summary
This document is a tally sheet for routine immunizations at a health center, clinic, or hospital in Ethiopia. It includes columns for antigens, tallies, and counts for children under one year and those over one year.
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Health Centre /Clinic/Hospital Routine Immunization Tally Sheet Region Zone/Subcity/Woreda Health Facility Name Begin Date End Date Routine Immunization Tally Sheet Woreda:__________________________ Facility...
Health Centre /Clinic/Hospital Routine Immunization Tally Sheet Region Zone/Subcity/Woreda Health Facility Name Begin Date End Date Routine Immunization Tally Sheet Woreda:__________________________ Facility: _______________ Year:__________________ Month:__________________ Type of session: □ static □ Outreach □ Mobile Under 1 year Childrens’ One year and older Childrens’ ANTIGEN Total Tally Count Tally Count BCG HepB BD within 24 Hrs HepB HepB BD after 24 Hrs- 14 days Pentavalent 1 Pentavalent Pentavalent 2 Pentavalent 3 OPV 1 OPV OPV 2 OPV 3 IPV1 IPV IPV2 PCV 1 PCV PCV 2 PCV 3 Rota 1 Rota Rota 2 Measles 1 (MCV1) Measles Meseals 2 (MCV2) Fully immunized Protected at Birth from NNT (PAB) Td all doses given (Td1-Td5) Doses Tally Count Td1 Td 2 Td 3 Td 4 Td 5
