DDFORMS.ORG – DD Form 3111 – Routine Immunization Screening Form: Adult – Immunizations are a vital part of keeping people safe and healthy. The DD Form 3111 is an important document used by medical providers to screen adults for immunization status. This form collects essential information that helps to ensure that the individual has received all necessary vaccinations and is up-to-date with the recommended immunization schedule. The form also allows healthcare providers to track a patient’s immunization history over time, making it easier to ensure that any needed vaccines have been administered.
Download DD Form 3111 – Routine Immunization Screening Form: Adult
| Form Number | DD Form 3111 |
| Form Title | Routine Immunization Screening Form: Adult |
| Edition Date | 3/11/2020 |
| File Size | 41 KB |
What is a DD Form 3111?
DD Form 3111 is a routine immunization screening form that is used to document immunizations for adults. This form, also known as the Adult Immunization Record, reflects all of the vaccines given in an individual’s lifetime and can be used for individuals over 18 years old. It is typically used by healthcare providers to record an adult patient’s vaccination history so that they can ensure their patients are up-to-date with their vaccinations. The form is designed to be completed in its entirety each time a new immunization or booster shot is administered. It includes sections on personal information, vaccine type and date received, administering provider, and clinic location. Additionally, it allows for any additional comments about the patient’s medical history or other notes related to the visit.
Where Can I Find a DD Form 3111?
The U.S. Department of Defense (DoD) has developed the DD Form 3111 to be used for routine immunization screenings for adults. This form contains information about a person’s health and immunization status, including details on any prior vaccinations received and any allergies or medical conditions that may affect their ability to receive certain immunizations. The DoD requires all adult service members and civilian contractors to complete the form prior to deployment or travel overseas.
DD Form 3111 is available online at the Defense Manpower Data Center website, which provides all the forms needed by DoD personnel in one convenient location. The website also provides instructions on how to fill out the form, as well as helpful tips for ensuring accuracy when completing it. The completed form must then be submitted directly to a designated medical facility or provider before an individual can receive their required vaccinations and/or deploy overseas.
DD Form 3111 – Routine Immunization Screening Form: Adult
The DD Form 3111 is a comprehensive medical document designed to screen adults for routine immunizations. This form helps healthcare providers determine which vaccinations are necessary and appropriate for each individual patient. It covers all the major immunization categories, including influenza, tetanus-diphtheria-acellular pertussis (Tdap), human papillomavirus (HPV), and others. The form also includes questions about any past immunizations received and any allergies or adverse reactions to medications that may affect vaccine administration. With this information in hand, doctors can make informed decisions about which vaccines should be administered to their patients.
The completion of this form requires knowledge about the patient’s medical history, as well as an understanding of the specific immunization requirements for each age group and risk factors associated with various diseases.
DD Form 3111 Example
