This page is for training and exercise purposes only
Please note that the information you enter on this form is not saved or stored in any way. Please print two forms. When picking up medication, one will be returned to you for your records and the other will be turned in to the Health Department.
Influenza Vaccine Screening Form
Anthrax Medication Screening Form
Plague Screening Form
Tularemia Screening Form
This form is provided by Dispense Assist: © Johnson County, Kansas Health Department