{"id":10566,"date":"2024-08-28T10:40:44","date_gmt":"2024-08-28T14:40:44","guid":{"rendered":"https:\/\/vaccines.phila.gov\/?post_type=portfolio_page&#038;p=10566"},"modified":"2026-02-09T09:57:20","modified_gmt":"2026-02-09T14:57:20","slug":"reporting-forms","status":"publish","type":"portfolio_page","link":"https:\/\/vaccines.phila.gov\/index.php\/portfolio_page\/reporting-forms\/","title":{"rendered":"Reporting Forms"},"content":{"rendered":"\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-9d6595d7 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<figure class=\"wp-block-image size-full multiple-resource-gallery is-style-default\"><img loading=\"lazy\" decoding=\"async\" width=\"600\" height=\"600\" src=\"https:\/\/vaccines.phila.gov\/wp-content\/uploads\/2025\/10\/adult-vaccine-reporting-form.png\" alt=\"\" class=\"wp-image-13017\" style=\"aspect-ratio:1;object-fit:cover\" srcset=\"https:\/\/vaccines.phila.gov\/wp-content\/uploads\/2025\/10\/adult-vaccine-reporting-form.png 600w, https:\/\/vaccines.phila.gov\/wp-content\/uploads\/2025\/10\/adult-vaccine-reporting-form-480x480.png 480w, https:\/\/vaccines.phila.gov\/wp-content\/uploads\/2025\/10\/adult-vaccine-reporting-form-150x150.png 150w, https:\/\/vaccines.phila.gov\/wp-content\/uploads\/2025\/10\/adult-vaccine-reporting-form-570x570.png 570w, https:\/\/vaccines.phila.gov\/wp-content\/uploads\/2025\/10\/adult-vaccine-reporting-form-500x500.png 500w, https:\/\/vaccines.phila.gov\/wp-content\/uploads\/2025\/10\/adult-vaccine-reporting-form-300x300.png 300w, https:\/\/vaccines.phila.gov\/wp-content\/uploads\/2025\/10\/adult-vaccine-reporting-form-100x100.png 100w\" sizes=\"auto, (max-width: 600px) 100vw, 600px\" \/><figcaption class=\"wp-element-caption\"><a href=\"\/wp-content\/uploads\/2026\/02\/Adult-Vaccine-and-Immunization-Reporting-Form-2-2-2026.pdf\" data-type=\"link\" data-id=\"\/wp-content\/uploads\/2026\/02\/Adult-Vaccine-and-Immunization-Reporting-Form-2-2-2026.pdf\">Adult Vaccine Reporting Form<\/a><\/figcaption><\/figure>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<figure class=\"wp-block-image size-full multiple-resource-gallery\"><img loading=\"lazy\" decoding=\"async\" width=\"600\" height=\"600\" src=\"https:\/\/vaccines.phila.gov\/wp-content\/uploads\/2025\/10\/pediatric-vaccine-reporting-form.png\" alt=\"\" class=\"wp-image-13018\" style=\"aspect-ratio:1;object-fit:cover\" srcset=\"https:\/\/vaccines.phila.gov\/wp-content\/uploads\/2025\/10\/pediatric-vaccine-reporting-form.png 600w, https:\/\/vaccines.phila.gov\/wp-content\/uploads\/2025\/10\/pediatric-vaccine-reporting-form-480x480.png 480w, https:\/\/vaccines.phila.gov\/wp-content\/uploads\/2025\/10\/pediatric-vaccine-reporting-form-150x150.png 150w, https:\/\/vaccines.phila.gov\/wp-content\/uploads\/2025\/10\/pediatric-vaccine-reporting-form-570x570.png 570w, https:\/\/vaccines.phila.gov\/wp-content\/uploads\/2025\/10\/pediatric-vaccine-reporting-form-500x500.png 500w, https:\/\/vaccines.phila.gov\/wp-content\/uploads\/2025\/10\/pediatric-vaccine-reporting-form-300x300.png 300w, https:\/\/vaccines.phila.gov\/wp-content\/uploads\/2025\/10\/pediatric-vaccine-reporting-form-100x100.png 100w\" sizes=\"auto, (max-width: 600px) 100vw, 600px\" \/><figcaption class=\"wp-element-caption\"><a href=\"\/wp-content\/uploads\/2026\/02\/Pediatric-Vaccine-Reporting-Form-2-2-2026.pdf\" data-type=\"link\" data-id=\"https:\/\/vaccines.phila.gov\/wp-content\/uploads\/2025\/03\/Pediatric-Vaccine-Reporting-Form-ResourceForms-3-11-2025.pdf\">Pediatric Vaccine Reporting Form<\/a><\/figcaption><\/figure>\n<\/div>\n<\/div>\n\n\n\n<div style=\"height:30px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-9d6595d7 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<figure class=\"wp-block-image size-full is-resized multiple-resource-gallery\"><img loading=\"lazy\" decoding=\"async\" width=\"600\" height=\"600\" src=\"https:\/\/vaccines.phila.gov\/wp-content\/uploads\/2025\/10\/flu-reporting-form.png\" alt=\"\" class=\"wp-image-13013\" style=\"object-fit:cover;width:554px;height:auto\" srcset=\"https:\/\/vaccines.phila.gov\/wp-content\/uploads\/2025\/10\/flu-reporting-form.png 600w, https:\/\/vaccines.phila.gov\/wp-content\/uploads\/2025\/10\/flu-reporting-form-480x480.png 480w, https:\/\/vaccines.phila.gov\/wp-content\/uploads\/2025\/10\/flu-reporting-form-150x150.png 150w, https:\/\/vaccines.phila.gov\/wp-content\/uploads\/2025\/10\/flu-reporting-form-570x570.png 570w, https:\/\/vaccines.phila.gov\/wp-content\/uploads\/2025\/10\/flu-reporting-form-500x500.png 500w, https:\/\/vaccines.phila.gov\/wp-content\/uploads\/2025\/10\/flu-reporting-form-300x300.png 300w, https:\/\/vaccines.phila.gov\/wp-content\/uploads\/2025\/10\/flu-reporting-form-100x100.png 100w\" sizes=\"auto, (max-width: 600px) 100vw, 600px\" \/><figcaption class=\"wp-element-caption\"><a href=\"\/wp-content\/uploads\/2026\/02\/Flu-Vaccine-Reporting-Form-1-12-2026.pdf\" data-type=\"link\" data-id=\"https:\/\/vaccines.phila.gov\/wp-content\/uploads\/2025\/03\/Flu-Vaccine-Reporting-Form-ResourceForms-3-5-2025.pdf\">Flu Vaccine Reporting Form<\/a><\/figcaption><\/figure>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<figure class=\"wp-block-image size-full is-resized multiple-resource-gallery\"><a href=\"\/wp-content\/uploads\/2024\/08\/v1NoDoseAdministered_PhilaVax_11-20-20.pdf\"><img loading=\"lazy\" decoding=\"async\" width=\"600\" height=\"600\" src=\"https:\/\/vaccines.phila.gov\/wp-content\/uploads\/2024\/08\/no-dose-report-01.jpg\" alt=\"\" class=\"wp-image-10575\" style=\"object-fit:cover;width:554px;height:auto\" srcset=\"https:\/\/vaccines.phila.gov\/wp-content\/uploads\/2024\/08\/no-dose-report-01.jpg 600w, https:\/\/vaccines.phila.gov\/wp-content\/uploads\/2024\/08\/no-dose-report-01-480x480.jpg 480w, https:\/\/vaccines.phila.gov\/wp-content\/uploads\/2024\/08\/no-dose-report-01-150x150.jpg 150w, https:\/\/vaccines.phila.gov\/wp-content\/uploads\/2024\/08\/no-dose-report-01-570x570.jpg 570w, https:\/\/vaccines.phila.gov\/wp-content\/uploads\/2024\/08\/no-dose-report-01-500x500.jpg 500w, https:\/\/vaccines.phila.gov\/wp-content\/uploads\/2024\/08\/no-dose-report-01-300x300.jpg 300w, https:\/\/vaccines.phila.gov\/wp-content\/uploads\/2024\/08\/no-dose-report-01-100x100.jpg 100w\" sizes=\"auto, (max-width: 600px) 100vw, 600px\" \/><\/a><figcaption class=\"wp-element-caption\"><a href=\"\/wp-content\/uploads\/2024\/08\/v1NoDoseAdministered_PhilaVax_11-20-20.pdf\">No Dose Administered Reporting Form<\/a><\/figcaption><\/figure>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"Adult Vaccine Reporting Form Pediatric Vaccine Reporting Form Flu Vaccine Reporting Form No Dose Administered Reporting Form","protected":false},"author":23,"featured_media":10567,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","portfolio_category":[128],"portfolio_tag":[],"class_list":["post-10566","portfolio_page","type-portfolio_page","status-publish","has-post-thumbnail","hentry","portfolio_category-philavax"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.7 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Reporting Forms - Philadelphia Immunization Program<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/vaccines.phila.gov\/index.php\/portfolio_page\/reporting-forms\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Reporting Forms - Philadelphia Immunization Program\" \/>\n<meta property=\"og:url\" content=\"https:\/\/vaccines.phila.gov\/index.php\/portfolio_page\/reporting-forms\/\" \/>\n<meta property=\"og:site_name\" content=\"Philadelphia Immunization Program\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/phillyhealth\/\" \/>\n<meta property=\"article:modified_time\" content=\"2026-02-09T14:57:20+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/vaccines.phila.gov\/wp-content\/uploads\/2024\/08\/reporting-forms-thumbnail-01.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"600\" \/>\n\t<meta property=\"og:image:height\" content=\"600\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/vaccines.phila.gov\\\/index.php\\\/portfolio_page\\\/reporting-forms\\\/\",\"url\":\"https:\\\/\\\/vaccines.phila.gov\\\/index.php\\\/portfolio_page\\\/reporting-forms\\\/\",\"name\":\"Reporting Forms - Philadelphia Immunization Program\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/vaccines.phila.gov\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/vaccines.phila.gov\\\/index.php\\\/portfolio_page\\\/reporting-forms\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/vaccines.phila.gov\\\/index.php\\\/portfolio_page\\\/reporting-forms\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/vaccines.phila.gov\\\/wp-content\\\/uploads\\\/2024\\\/08\\\/reporting-forms-thumbnail-01.jpg\",\"datePublished\":\"2024-08-28T14:40:44+00:00\",\"dateModified\":\"2026-02-09T14:57:20+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/vaccines.phila.gov\\\/index.php\\\/portfolio_page\\\/reporting-forms\\\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/vaccines.phila.gov\\\/index.php\\\/portfolio_page\\\/reporting-forms\\\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/vaccines.phila.gov\\\/index.php\\\/portfolio_page\\\/reporting-forms\\\/#primaryimage\",\"url\":\"https:\\\/\\\/vaccines.phila.gov\\\/wp-content\\\/uploads\\\/2024\\\/08\\\/reporting-forms-thumbnail-01.jpg\",\"contentUrl\":\"https:\\\/\\\/vaccines.phila.gov\\\/wp-content\\\/uploads\\\/2024\\\/08\\\/reporting-forms-thumbnail-01.jpg\",\"width\":600,\"height\":600},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/vaccines.phila.gov\\\/index.php\\\/portfolio_page\\\/reporting-forms\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/vaccines.phila.gov\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Portfolio\",\"item\":\"https:\\\/\\\/vaccines.phila.gov\\\/index.php\\\/portfolio_page\\\/\"},{\"@type\":\"ListItem\",\"position\":3,\"name\":\"Reporting Forms\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/vaccines.phila.gov\\\/#website\",\"url\":\"https:\\\/\\\/vaccines.phila.gov\\\/\",\"name\":\"Philadelphia Immunization Program\",\"description\":\"Immunization Program of the Philadelphia Department of Public Health\",\"publisher\":{\"@id\":\"https:\\\/\\\/vaccines.phila.gov\\\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/vaccines.phila.gov\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"},{\"@type\":\"Organization\",\"@id\":\"https:\\\/\\\/vaccines.phila.gov\\\/#organization\",\"name\":\"Philadelphia Immunization Program\",\"url\":\"https:\\\/\\\/vaccines.phila.gov\\\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/vaccines.phila.gov\\\/#\\\/schema\\\/logo\\\/image\\\/\",\"url\":\"https:\\\/\\\/vaccines.phila.gov\\\/wp-content\\\/uploads\\\/2026\\\/05\\\/ImmunizationProgram-Logo-White-scaled.png\",\"contentUrl\":\"https:\\\/\\\/vaccines.phila.gov\\\/wp-content\\\/uploads\\\/2026\\\/05\\\/ImmunizationProgram-Logo-White-scaled.png\",\"width\":2560,\"height\":501,\"caption\":\"Philadelphia Immunization Program\"},\"image\":{\"@id\":\"https:\\\/\\\/vaccines.phila.gov\\\/#\\\/schema\\\/logo\\\/image\\\/\"},\"sameAs\":[\"https:\\\/\\\/www.facebook.com\\\/phillyhealth\\\/\",\"https:\\\/\\\/www.instagram.com\\\/phlpublichealth\\\/?hl=en\",\"https:\\\/\\\/www.youtube.com\\\/@phillyimmz\\\/videos\"]}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Reporting Forms - Philadelphia Immunization Program","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/vaccines.phila.gov\/index.php\/portfolio_page\/reporting-forms\/","og_locale":"en_US","og_type":"article","og_title":"Reporting Forms - Philadelphia Immunization Program","og_url":"https:\/\/vaccines.phila.gov\/index.php\/portfolio_page\/reporting-forms\/","og_site_name":"Philadelphia Immunization Program","article_publisher":"https:\/\/www.facebook.com\/phillyhealth\/","article_modified_time":"2026-02-09T14:57:20+00:00","og_image":[{"width":600,"height":600,"url":"https:\/\/vaccines.phila.gov\/wp-content\/uploads\/2024\/08\/reporting-forms-thumbnail-01.jpg","type":"image\/jpeg"}],"twitter_card":"summary_large_image","schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/vaccines.phila.gov\/index.php\/portfolio_page\/reporting-forms\/","url":"https:\/\/vaccines.phila.gov\/index.php\/portfolio_page\/reporting-forms\/","name":"Reporting Forms - Philadelphia Immunization Program","isPartOf":{"@id":"https:\/\/vaccines.phila.gov\/#website"},"primaryImageOfPage":{"@id":"https:\/\/vaccines.phila.gov\/index.php\/portfolio_page\/reporting-forms\/#primaryimage"},"image":{"@id":"https:\/\/vaccines.phila.gov\/index.php\/portfolio_page\/reporting-forms\/#primaryimage"},"thumbnailUrl":"https:\/\/vaccines.phila.gov\/wp-content\/uploads\/2024\/08\/reporting-forms-thumbnail-01.jpg","datePublished":"2024-08-28T14:40:44+00:00","dateModified":"2026-02-09T14:57:20+00:00","breadcrumb":{"@id":"https:\/\/vaccines.phila.gov\/index.php\/portfolio_page\/reporting-forms\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/vaccines.phila.gov\/index.php\/portfolio_page\/reporting-forms\/"]}]},{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/vaccines.phila.gov\/index.php\/portfolio_page\/reporting-forms\/#primaryimage","url":"https:\/\/vaccines.phila.gov\/wp-content\/uploads\/2024\/08\/reporting-forms-thumbnail-01.jpg","contentUrl":"https:\/\/vaccines.phila.gov\/wp-content\/uploads\/2024\/08\/reporting-forms-thumbnail-01.jpg","width":600,"height":600},{"@type":"BreadcrumbList","@id":"https:\/\/vaccines.phila.gov\/index.php\/portfolio_page\/reporting-forms\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/vaccines.phila.gov\/"},{"@type":"ListItem","position":2,"name":"Portfolio","item":"https:\/\/vaccines.phila.gov\/index.php\/portfolio_page\/"},{"@type":"ListItem","position":3,"name":"Reporting Forms"}]},{"@type":"WebSite","@id":"https:\/\/vaccines.phila.gov\/#website","url":"https:\/\/vaccines.phila.gov\/","name":"Philadelphia Immunization Program","description":"Immunization Program of the Philadelphia Department of Public Health","publisher":{"@id":"https:\/\/vaccines.phila.gov\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/vaccines.phila.gov\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"},{"@type":"Organization","@id":"https:\/\/vaccines.phila.gov\/#organization","name":"Philadelphia Immunization Program","url":"https:\/\/vaccines.phila.gov\/","logo":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/vaccines.phila.gov\/#\/schema\/logo\/image\/","url":"https:\/\/vaccines.phila.gov\/wp-content\/uploads\/2026\/05\/ImmunizationProgram-Logo-White-scaled.png","contentUrl":"https:\/\/vaccines.phila.gov\/wp-content\/uploads\/2026\/05\/ImmunizationProgram-Logo-White-scaled.png","width":2560,"height":501,"caption":"Philadelphia Immunization Program"},"image":{"@id":"https:\/\/vaccines.phila.gov\/#\/schema\/logo\/image\/"},"sameAs":["https:\/\/www.facebook.com\/phillyhealth\/","https:\/\/www.instagram.com\/phlpublichealth\/?hl=en","https:\/\/www.youtube.com\/@phillyimmz\/videos"]}]}},"_links":{"self":[{"href":"https:\/\/vaccines.phila.gov\/index.php\/wp-json\/wp\/v2\/portfolio_page\/10566","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/vaccines.phila.gov\/index.php\/wp-json\/wp\/v2\/portfolio_page"}],"about":[{"href":"https:\/\/vaccines.phila.gov\/index.php\/wp-json\/wp\/v2\/types\/portfolio_page"}],"author":[{"embeddable":true,"href":"https:\/\/vaccines.phila.gov\/index.php\/wp-json\/wp\/v2\/users\/23"}],"replies":[{"embeddable":true,"href":"https:\/\/vaccines.phila.gov\/index.php\/wp-json\/wp\/v2\/comments?post=10566"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vaccines.phila.gov\/index.php\/wp-json\/wp\/v2\/media\/10567"}],"wp:attachment":[{"href":"https:\/\/vaccines.phila.gov\/index.php\/wp-json\/wp\/v2\/media?parent=10566"}],"wp:term":[{"taxonomy":"portfolio_category","embeddable":true,"href":"https:\/\/vaccines.phila.gov\/index.php\/wp-json\/wp\/v2\/portfolio_category?post=10566"},{"taxonomy":"portfolio_tag","embeddable":true,"href":"https:\/\/vaccines.phila.gov\/index.php\/wp-json\/wp\/v2\/portfolio_tag?post=10566"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}