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    Rite Aid Immunization Evaluation Report

    Name:_______________________________

    Here are the immunizations that may be recommended based on the immunization history and the answers you entered into the Rite Aid immunization Evaluation Questionnaire. This should be printed out and discussed with your Rite Aid pharmacist or health care provider before any immunizations are given.

    *IMPORTANT: Only immunizations that may be required in the next 12 months are reported above. All answers are completely confidential, will not be stored and are not associated with your name when results are printed. The recommendations you will receive are not substitute for medical consultation or medical advice. All recommendations should be reviewed with a certified immunizing pharmacist or a health provider before any immunizations are given.

     

    **Certain vaccinations may not be available in all locations. The availability of vaccines may depend upon state law. Age restrictions may vary by state. Please contact your Rite Aid Pharmacy to learn more.

    To receive a copy of your complete medication history, please see your local Rite Aid pharmacist.

    This report contains patient information which is legally protected.

    This information must be used and stored in accordance with Rite Aid privacy policies.