AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 16777
TITLE: Immunization informed consent cards
DATES: 1990-
ARRANGEMENT: Alphabetical by patient's 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 78-14-5 (1992). 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 authorized by Archives general schedule Patient and client case files, GRS-1706

AUTHORIZED: 06/20/2019

FORMAT MANAGEMENT

Paper: Retain in Office for 7 years after last visit and then destroy.

APPRAISAL

Administrative Legal

The retention of these records is based on Administrative Code R432-100-34(4)(c) and (d)(2018).

PRIMARY DESIGNATION

Private

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