INSTRUCTIONS 
1. A record will be kept on this form of all vaccina¬ 
tions given under the direction of medical officers to 
military and civilian personnel resident with military 
commands. See A. It. 40—215 for further details. 
2. Appropriate entries will be made at the time 
prophylactic vaccinations are made and the entries will 
be authenticated by the initials of the medical officer mak¬ 
ing the inoculation. 
3. In the case of a civilian employee, the character 
of his employment (clerk, teamster, etc.) and the staff 
corps or department in which he is employed will be 
noted in the space Regiment or Staff Corps. A brief 
notation of the status of other civilians will be made 
in the same spaces. 
4. All officers and warrant officers furnished com¬ 
pleted vaccination registers will preserve them and will 
exhibit them to examining medical officers at the annual 
physical examination. The medical examining officer 
will transcribe pertinent immunization data to the 
report of the annual physical examination. 
5. The duplicate copy of the immunization register 
will be filed alphabetically in a Medical Department 
immunization file at the station or command to which 
the individual belongs. 
6. Record as vaccina, vaccinoid, or immune reaction. 
If there is no reaction, or if the reaction fails to con¬ 
form to any of the three recognized types, vaccination 
will be repeated. The use of the term “unsuccessful 
vaccination” on official records will not be used. 
Form 81 
MEDICAL DEPARTMENT, U. S. A. 
(Revised January 23, 1941) 
la—20202 
