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Completing the International Certificate of Vaccination or Prophylaxis (ICVP) for

Poliomyelitis (Scotland)

P ersons receiving polio vaccination under the WHO International Health Regulations (IHR)

Temporary Recommendations should

be provided with an ICVP. No departure from this certificate is permitted. Any amendment of the certificate or erasure or failure to complete any part may render the certificate invalid (to include completion of the details with regard to the manufacturer and batch number of the vaccine given).

Example of how to complete the ICVP

T

his is to certify that (name).........Joe Bloggs..................................................................

dat

e of birth...1 January 1963..........sex......Male.......................................................

nat

ionality............British........................ ...................................................................

nat ional identification document if applicable................................................................ w

hose signature follows............................................................................................................

has on the date indicated been vaccinated or received prophylaxis against: (name of disease or condition) T he International Certificate of Vaccination or Prophylaxis (for poliomyelitis) is valid for a period of 1 year. This is likely to commence from the date of vaccination. T he International Certificate is an individual certificate and cannot be used for more than one person. A separate certificate should be issued for children. A parent or guardian should sign a certificate that is issued to a child who is unable to write. If that parent or guardian is either illiterate or otherwise unable to write, it will be permissible to indicate a signature by that person's mark together with the indication of another person that the mark made is the mark of the person concerned. T he certificate must be printed in English and French and completed in English or French; an additional language may be added. In the UK the certificates conforming to the IHR model are preprinted. In Scotland these can be obtained from HPS by contacting Mary

O'Neill, TRAVAX administrator (email:

mary.oneill@nhs.net)

Vaccine or

prophylaxis

Date Signature and

professional status supervising clinician

Manufacturer

and batch no. of vaccine or prophylaxis

Certificate valid

From....

Until.....

Official stamp

of administering centre 1.Poliomyelitis17 June 2014
M RCGP

Sanofi Pasteur

MSD

Batch: ******

17 June 2014 -

16 June 2015

2. Stamp of

centre , surgery or clinicquotesdbs_dbs17.pdfusesText_23