予よ診しん票ひょう

noun

prevaccination screening questionnaire

A form used before vaccination to check for allergies, current health conditions, or other risk factors.

• ワクチン接せっ種しゅの前まえに、予よ診しん票ひょうに必ひつ要よう事じ項こうを記き入にゅうしてください。

  Please fill out the prevaccination screening questionnaire before receiving the vaccine.