vaccination ONLY OFFICE TO COMPLETE BELOW GRITS DATA COLLECTION FORM - OfficeGRITS DATA ENTRY FOR INTEGRATION WITH OFFICE ALLYPatient Last Name:Patient First Name:Verified In Grits? Yes NoVerified ByDateReceiving today: 1st 2nd Booster Moderna Pfizer Johnson and Johnson OtherDate of Vaccination:Name of Vaccine:Site-Deltoid : Right OR LeftDose:Lot Number:Exp Date of Vaccine:Who Administered Vaccine:Was Vaccine Information Sheet (Vis) Information Given: Yes NoTime Vaccine Given:Time Observation Ends:Adverse Reactions:Observed By:Submit Form
