Vaccination Certificate

🔍 Patient Lookup

HN (Hospital Number)

📋 Certificate Type

General Record HCP Certificate

📄 Document Information

Date

Evidence:

Vaccination Passport/Yellow book Original cert (Thai)

Medical cert from:

Other:

👤 Patient Information

Title

Mr Ms Mrs

Full Name (English) *

Full Name (Thai)

Date of Birth

Age

Passport/ID No.

ID Type

Passport National ID

👶 Childhood/EPI Vaccines

His/Her vaccination history could be summarized as followed (dd/mm/yyyy):

Vaccine	1st Dose	2nd Dose	3rd Dose	4th Dose	5th Dose
BCG Vaccine
Hepatitis B vaccine
Diphtheria-Pertussis-Tetanus (DPT)
OPV/IPV Vaccine
Measles-Mumps-Rubella (MMR)
Japanese Encephalitis

🧑 Adult & Travel Vaccines

Vaccine	1st Dose	2nd Dose	3rd Dose	4th Dose	5th Dose
Hepatitis A vaccine
Hepatitis A&B vaccine (Twinrix)
Varicella (Chicken pox) vaccine
Meningococcal (MCV4)
dT Tdap Tdap-IPV vaccine
Influenza vaccine
COVID-19 vaccine

➕ Add Custom Vaccine

Select or Type Vaccine Name

🫁 TB Testing (Optional)

Include TB Testing on Certificate

Tuberculin Skin Test (TST)

Test Date

Read Date

Induration Size (mm)

Interpretation

IGRA (Quantiferon)

Date Drawn

Result

Chest X-ray (CXR)

Date

Result/Findings

🩸 HBV Testing (Optional)

Include HBV Testing on Certificate

Test Date

HBsAg

Anti-HBs

Follow-up (Optional)

Booster Shot Date

Repeat Test Date

Repeat Anti-HBs

🩸 Hepatitis A Testing (Optional)

Include Hepatitis A Testing on Certificate

🧪 VZV Testing (Optional)

Include VZV Testing on Certificate

👨‍⚕️ Physician

Search by Name or License (ว.)

⚙️ Export Options

Date Format for Export

dd/mm/yyyy mm/dd/yyyy

Print Language

English Thai (ไทย)