{ "document_id": 14117, "page": 2, "width_pt": 612, "height_pt": 792, "rotation": 0, "pipeline_version": "paddleocr-vl-1.6+paul-48", "engine": "paddleocr_vl", "source_run_id": 14228, "item_count": 317, "counts_by_type": { "footer": 2, "form_field": 109, "header": 1, "heading": 2, "list": 1, "list_item": 6, "table": 2, "table_cell": 190, "text": 4 }, "build_ms": 26, "items": [ { "id": "p2.1", "order": 1, "type": "header", "bbox": { "l": 530.64, "t": 777.84, "r": 576.48, "b": 769.44 }, "text": "PAGE 2 OF 2", "attrs": { "block_label": "header" }, "level": 2 }, { "id": "p2.2", "order": 2, "type": "heading", "bbox": { "l": 33.36, "t": 765.84, "r": 214.8, "b": 733.68 }, "text": "Vaccine Administration Record for Adults (continued)", "attrs": { "block_label": "paragraph_title" }, "level": 3 }, { "id": "p2.3", "order": 3, "type": "text", "bbox": { "l": 33.36, "t": 721.44, "r": 317.76, "b": 677.76 }, "text": "Before administering any vaccines, give the patient copies of all pertinent Vaccine Information Statements (VISs) and make sure he/she understands the risks and benefits of the vaccine(s). Always provide or update the patient's personal record card.\nPatient name___" }, { "id": "p2.4", "order": 4, "type": "text", "bbox": { "l": 339.36, "t": 763.2, "r": 576.48, "b": 752.64 }, "text": "Patient name", "children": [ { "id": "p2.4.1", "order": 5, "type": "form_field", "bbox": { "l": 390.72, "t": 769.44, "r": 576.12, "b": 755.16 }, "text": "", "attrs": { "field_kind": "text", "label": "Patient name", "pdf_field_name": "Patient name_2", "source": "acroform", "label_source": "parent_text", "label_ref": "p2.4", "text_offset": 12, "text_span": 0 } } ] }, { "id": "p2.5", "order": 6, "type": "text", "bbox": { "l": 339.36, "t": 748.08, "r": 576.48, "b": 737.04 }, "text": "Birthdate ___ Chart number ___", "children": [ { "id": "p2.5.1", "order": 7, "type": "form_field", "bbox": { "l": 375.6, "t": 753.36, "r": 466.44, "b": 739.08 }, "text": "", "attrs": { "field_kind": "text", "label": "Birthdate", "pdf_field_name": "Birthdate_2", "source": "acroform", "label_source": "parent_text", "label_ref": "p2.5", "text_offset": 10, "text_span": 3 } }, { "id": "p2.5.2", "order": 8, "type": "form_field", "bbox": { "l": 519.6, "t": 753.36, "r": 576.12, "b": 739.08 }, "text": "", "attrs": { "field_kind": "text", "label": "Chart number", "pdf_field_name": "Chart number_2", "source": "acroform", "label_source": "parent_text", "label_ref": "p2.5", "text_offset": 27, "text_span": 3 } } ] }, { "id": "p2.6", "order": 9, "type": "text", "bbox": { "l": 341.04, "t": 727.2, "r": 575.52, "b": 680.88 }, "text": "PRACTICE NAME AND ADDRESS", "children": [ { "id": "p2.6.1", "order": 10, "type": "form_field", "bbox": { "l": 444, "t": 726.72, "r": 574.68, "b": 681.6 }, "text": "", "attrs": { "field_kind": "text", "label": "PRACTICE NAME AND ADDRESS", "pdf_field_name": "practice name and address_2", "source": "acroform", "label_source": "parent_text", "label_ref": "p2.6", "text_offset": 25, "text_span": 0 } } ] }, { "id": "p2.7", "order": 11, "type": "table", "bbox": { "l": 35.04, "t": 662.64, "r": 577.2, "b": 257.76 }, "text": "", "attrs": { "block_label": "table", "n_rows": 19, "n_cols": 10, "integrity": { "cells_checked": 15, "cells_flagged": 1, "flags": [ { "row": 14, "col": 0, "coverage": 0.3, "text": "Pneumococcal polysaccharide (e.g., PPSV23) Give PPSV23 IM o…" } ] } }, "children": [ { "id": "p2.7.1", "order": 12, "type": "table_cell", "bbox": { "l": 68.4465, "t": 648.4001000000001, "r": 100.0165, "b": 636.9001000000001 }, "text": "Vaccine", "attrs": { "row": 0, "col": 0, "rowspan": 2, "colspan": 1, "bbox_refit": true, "column_header": true, "header_source": "pdf" } }, { "id": "p2.7.2", "order": 13, "type": "table_cell", "bbox": { "l": 155.4624, "t": 651.9501, "r": 183.0501, "b": 633.7501 }, "text": "Type of Vaccine ^{{1}}", "attrs": { "row": 0, "col": 1, "rowspan": 2, "colspan": 1, "bbox_refit": true, "column_header": true, "header_source": "pdf" }, "children": [ { "id": "p2.7.2.1", "order": 14, "type": "form_field", "bbox": { "l": 132.96, "t": 551.52, "r": 206.04, "b": 537.96 }, "text": "", "attrs": { "field_kind": "text", "label": "Type of Vaccine ^{{1}}", "pdf_field_name": "Type of Vaccine1Influenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3_6", "source": "acroform", "row": 0, "col": 1, "rowspan": 2, "colspan": 1, "label_source": "parent_text", "label_ref": "p2.7.2" } }, { "id": "p2.7.2.2", "order": 15, "type": "form_field", "bbox": { "l": 132.96, "t": 537.24, "r": 206.04, "b": 523.68 }, "text": "", "attrs": { "field_kind": "text", "label": "Type of Vaccine ^{{1}}", "pdf_field_name": "Type of Vaccine1Influenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3_7", "source": "acroform", "row": 0, "col": 1, "rowspan": 2, "colspan": 1, "label_source": "parent_text", "label_ref": "p2.7.2" } }, { "id": "p2.7.2.3", "order": 16, "type": "form_field", "bbox": { "l": 132.96, "t": 480.24, "r": 206.04, "b": 466.68 }, "text": "", "attrs": { "field_kind": "text", "label": "Type of Vaccine ^{{1}}", "pdf_field_name": "Type of Vaccine1Influenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3_11", "source": "acroform", "row": 0, "col": 1, "rowspan": 2, "colspan": 1, "label_source": "parent_text", "label_ref": "p2.7.2" } }, { "id": "p2.7.2.4", "order": 17, "type": "form_field", "bbox": { "l": 132.96, "t": 465.96, "r": 206.04, "b": 452.4 }, "text": "", "attrs": { "field_kind": "text", "label": "Type of Vaccine ^{{1}}", "pdf_field_name": "Type of Vaccine1Influenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3_12", "source": "acroform", "row": 0, "col": 1, "rowspan": 2, "colspan": 1, "label_source": "parent_text", "label_ref": "p2.7.2" } }, { "id": "p2.7.2.5", "order": 18, "type": "form_field", "bbox": { "l": 132.96, "t": 451.68, "r": 206.04, "b": 438.24 }, "text": "", "attrs": { "field_kind": "text", "label": "Type of Vaccine ^{{1}}", "pdf_field_name": "Type of Vaccine1Influenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3_13", "source": "acroform", "row": 0, "col": 1, "rowspan": 2, "colspan": 1, "label_source": "parent_text", "label_ref": "p2.7.2" } } ] }, { "id": "p2.7.3", "order": 19, "type": "table_cell", "bbox": { "l": 209.6535, "t": 656.2001, "r": 251.20974, "b": 629.0801 }, "text": "Date vaccine given (mo/day/yr)", "attrs": { "row": 0, "col": 2, "rowspan": 2, "colspan": 1, "bbox_refit": true, "column_header": true, "header_source": "pdf" }, "children": [ { "id": "p2.7.3.1", "order": 20, "type": "form_field", "bbox": { "l": 207.36, "t": 551.52, "r": 254.28, "b": 537.96 }, "text": "", "attrs": { "field_kind": "text", "label": "Date vaccine given (mo/day/yr)", "pdf_field_name": "Date vaccine given modayyrInfluenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3_6", "source": "acroform", "row": 0, "col": 2, "rowspan": 2, "colspan": 1, "label_source": "parent_text", "label_ref": "p2.7.3" } }, { "id": "p2.7.3.2", "order": 21, "type": "form_field", "bbox": { "l": 207.36, "t": 465.96, "r": 254.28, "b": 452.4 }, "text": "", "attrs": { "field_kind": "text", "label": "Date vaccine given (mo/day/yr)", "pdf_field_name": "Date vaccine given modayyrInfluenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3_12", "source": "acroform", "row": 0, "col": 2, "rowspan": 2, "colspan": 1, "label_source": "parent_text", "label_ref": "p2.7.3" } }, { "id": "p2.7.3.3", "order": 22, "type": "form_field", "bbox": { "l": 207.36, "t": 451.68, "r": 254.28, "b": 438.24 }, "text": "", "attrs": { "field_kind": "text", "label": "Date vaccine given (mo/day/yr)", "pdf_field_name": "Date vaccine given modayyrInfluenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3_13", "source": "acroform", "row": 0, "col": 2, "rowspan": 2, "colspan": 1, "label_source": "parent_text", "label_ref": "p2.7.3" } } ] }, { "id": "p2.7.4", "order": 23, "type": "table_cell", "bbox": { "l": 258.9521, "t": 656.2001, "r": 286.4481, "b": 629.0801 }, "text": "Funding Source (F,S,P) ^{{2}}", "attrs": { "row": 0, "col": 3, "rowspan": 2, "colspan": 1, "bbox_refit": true, "column_header": true, "header_source": "pdf" }, "children": [ { "id": "p2.7.4.1", "order": 24, "type": "form_field", "bbox": { "l": 255.6, "t": 551.52, "r": 289.68, "b": 537.96 }, "text": "", "attrs": { "field_kind": "text", "label": "Funding Source (F,S,P) ^{{2}}", "pdf_field_name": "Funding Source FSP2Influenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3_6", "source": "acroform", "row": 0, "col": 3, "rowspan": 2, "colspan": 1, "label_source": "parent_text", "label_ref": "p2.7.4" } }, { "id": "p2.7.4.2", "order": 25, "type": "form_field", "bbox": { "l": 255.6, "t": 465.96, "r": 289.68, "b": 452.4 }, "text": "", "attrs": { "field_kind": "text", "label": "Funding Source (F,S,P) ^{{2}}", "pdf_field_name": "Funding Source FSP2Influenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3_12", "source": "acroform", "row": 0, "col": 3, "rowspan": 2, "colspan": 1, "label_source": "parent_text", "label_ref": "p2.7.4" } } ] }, { "id": "p2.7.5", "order": 26, "type": "table_cell", "bbox": { "l": 294.8417, "t": 656.16, "r": 316.4695, "b": 628.96 }, "text": "Route ^{{3}} and Site ^{{3}}", "attrs": { "row": 0, "col": 4, "rowspan": 2, "colspan": 1, "bbox_refit": true, "column_header": true, "header_source": "pdf" }, "children": [ { "id": "p2.7.5.1", "order": 27, "type": "form_field", "bbox": { "l": 291, "t": 551.52, "r": 320.16, "b": 537.96 }, "text": "", "attrs": { "field_kind": "text", "label": "Route ^{{3}} and Site ^{{3}}", "pdf_field_name": "Route3 and Site3Influenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3_6", "source": "acroform", "row": 0, "col": 4, "rowspan": 2, "colspan": 1, "label_source": "parent_text", "label_ref": "p2.7.5" } }, { "id": "p2.7.5.2", "order": 28, "type": "form_field", "bbox": { "l": 291, "t": 537.24, "r": 320.16, "b": 523.68 }, "text": "", "attrs": { "field_kind": "text", "label": "Route ^{{3}} and Site ^{{3}}", "pdf_field_name": "Route3 and Site3Influenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3_7", "source": "acroform", "row": 0, "col": 4, "rowspan": 2, "colspan": 1, "label_source": "parent_text", "label_ref": "p2.7.5" } }, { "id": "p2.7.5.3", "order": 29, "type": "form_field", "bbox": { "l": 291, "t": 522.96, "r": 320.16, "b": 509.4 }, "text": "", "attrs": { "field_kind": "text", "label": "Route ^{{3}} and Site ^{{3}}", "pdf_field_name": "Route3 and Site3Influenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3_8", "source": "acroform", "row": 0, "col": 4, "rowspan": 2, "colspan": 1, "label_source": "parent_text", "label_ref": "p2.7.5" } }, { "id": "p2.7.5.4", "order": 30, "type": "form_field", "bbox": { "l": 291, "t": 508.68, "r": 320.16, "b": 495.24 }, "text": "", "attrs": { "field_kind": "text", "label": "Route ^{{3}} and Site ^{{3}}", "pdf_field_name": "Route3 and Site3Influenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3_9", "source": "acroform", "row": 0, "col": 4, "rowspan": 2, "colspan": 1, "label_source": "parent_text", "label_ref": "p2.7.5" } }, { "id": "p2.7.5.5", "order": 31, "type": "form_field", "bbox": { "l": 291, "t": 494.52, "r": 320.16, "b": 480.96 }, "text": "", "attrs": { "field_kind": "text", "label": "Route ^{{3}} and Site ^{{3}}", "pdf_field_name": "Route3 and Site3Influenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3_10", "source": "acroform", "row": 0, "col": 4, "rowspan": 2, "colspan": 1, "label_source": "parent_text", "label_ref": "p2.7.5" } }, { "id": "p2.7.5.6", "order": 32, "type": "form_field", "bbox": { "l": 291, "t": 480.24, "r": 320.16, "b": 466.68 }, "text": "", "attrs": { "field_kind": "text", "label": "Route ^{{3}} and Site ^{{3}}", "pdf_field_name": "Route3 and Site3Influenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3_11", "source": "acroform", "row": 0, "col": 4, "rowspan": 2, "colspan": 1, "label_source": "parent_text", "label_ref": "p2.7.5" } }, { "id": "p2.7.5.7", "order": 33, "type": "form_field", "bbox": { "l": 291, "t": 465.96, "r": 320.16, "b": 452.4 }, "text": "", "attrs": { "field_kind": "text", "label": "Route ^{{3}} and Site ^{{3}}", "pdf_field_name": "Route3 and Site3Influenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3_12", "source": "acroform", "row": 0, "col": 4, "rowspan": 2, "colspan": 1, "label_source": "parent_text", "label_ref": "p2.7.5" } }, { "id": "p2.7.5.8", "order": 34, "type": "form_field", "bbox": { "l": 291, "t": 451.68, "r": 320.16, "b": 438.24 }, "text": "", "attrs": { "field_kind": "text", "label": "Route ^{{3}} and Site ^{{3}}", "pdf_field_name": "Route3 and Site3Influenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3_13", "source": "acroform", "row": 0, "col": 4, "rowspan": 2, "colspan": 1, "label_source": "parent_text", "label_ref": "p2.7.5" } }, { "id": "p2.7.5.9", "order": 35, "type": "form_field", "bbox": { "l": 291, "t": 437.52, "r": 320.16, "b": 423.96 }, "text": "", "attrs": { "field_kind": "text", "label": "Route ^{{3}} and Site ^{{3}}", "pdf_field_name": "Route3 and Site3Influenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3_14", "source": "acroform", "row": 0, "col": 4, "rowspan": 2, "colspan": 1, "label_source": "parent_text", "label_ref": "p2.7.5" } }, { "id": "p2.7.5.10", "order": 36, "type": "form_field", "bbox": { "l": 291, "t": 423.24, "r": 320.16, "b": 410.04 }, "text": "", "attrs": { "field_kind": "text", "label": "Route ^{{3}} and Site ^{{3}}", "pdf_field_name": "Route3 and Site3Influenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3_15", "source": "acroform", "row": 0, "col": 4, "rowspan": 2, "colspan": 1, "label_source": "parent_text", "label_ref": "p2.7.5" } } ] }, { "id": "p2.7.6", "order": 37, "type": "table_cell", "bbox": { "l": 358.9535, "t": 654.2001, "r": 384.2095, "b": 645.0001 }, "text": "Vaccine", "attrs": { "row": 0, "col": 5, "rowspan": 1, "colspan": 2, "bbox_refit": true, "column_header": true, "header_source": "pdf" } }, { "id": "p2.7.7", "order": 38, "type": "table_cell", "bbox": { "l": 437.9598, "t": 658.1201, "r": 504.9038, "b": 639.9201 }, "text": "Vaccine Information Statement (VIS)", "attrs": { "row": 0, "col": 6, "rowspan": 1, "colspan": 2, "bbox_refit": true, "column_header": true, "header_source": "pdf" }, "children": [ { "id": "p2.7.7.1", "order": 39, "type": "form_field", "bbox": { "l": 519.48, "t": 622.44, "r": 574.92, "b": 609.24 }, "text": "", "attrs": { "field_kind": "text", "label": "VIS", "pdf_field_name": "Vaccinator5 signature or initials and titleInfluenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3", "source": "acroform", "row": 0, "col": 6, "rowspan": 1, "colspan": 2, "label_source": "parent_text", "label_ref": "p2.7.7" } } ] }, { "id": "p2.7.8", "order": 40, "type": "table_cell", "bbox": { "l": 523.5649, "t": 654.4001000000001, "r": 570.8359, "b": 629.5361 }, "text": "Vaccinator ^{{5}} (signature or initials and title)", "attrs": { "row": 0, "col": 7, "rowspan": 2, "colspan": 1, "bbox_refit": true, "column_header": true, "header_source": "pdf" }, "children": [ { "id": "p2.7.8.1", "order": 41, "type": "form_field", "bbox": { "l": 519.48, "t": 608.52, "r": 574.92, "b": 594.96 }, "text": "", "attrs": { "field_kind": "text", "label": "signature or initials and title", "pdf_field_name": "Vaccinator5 signature or initials and titleInfluenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3_2", "source": "acroform", "row": 0, "col": 7, "rowspan": 2, "colspan": 1, "label_source": "parent_text", "label_ref": "p2.7.8" } }, { "id": "p2.7.8.2", "order": 42, "type": "form_field", "bbox": { "l": 519.48, "t": 594.24, "r": 574.92, "b": 580.68 }, "text": "", "attrs": { "field_kind": "text", "label": "Vaccinator ^{{5}} (signature or initials and title)", "pdf_field_name": "Vaccinator5 signature or initials and titleInfluenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3_3", "source": "acroform", "row": 0, "col": 7, "rowspan": 2, "colspan": 1, "label_source": "parent_text", "label_ref": "p2.7.8" } }, { "id": "p2.7.8.3", "order": 43, "type": "form_field", "bbox": { "l": 519.48, "t": 551.52, "r": 574.92, "b": 537.96 }, "text": "", "attrs": { "field_kind": "text", "label": "Vaccinator ^{{5}} (signature or initials and title)", "pdf_field_name": "Vaccinator5 signature or initials and titleInfluenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3_6", "source": "acroform", "row": 0, "col": 7, "rowspan": 2, "colspan": 1, "label_source": "parent_text", "label_ref": "p2.7.8" } }, { "id": "p2.7.8.4", "order": 44, "type": "form_field", "bbox": { "l": 519.48, "t": 465.96, "r": 574.92, "b": 452.4 }, "text": "", "attrs": { "field_kind": "text", "label": "Vaccinator ^{{5}} (signature or initials and title)", "pdf_field_name": "Vaccinator5 signature or initials and titleInfluenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3_12", "source": "acroform", "row": 0, "col": 7, "rowspan": 2, "colspan": 1, "label_source": "parent_text", "label_ref": "p2.7.8" } }, { "id": "p2.7.8.5", "order": 45, "type": "form_field", "bbox": { "l": 519.48, "t": 451.68, "r": 574.92, "b": 438.24 }, "text": "", "attrs": { "field_kind": "text", "label": "Vaccinator ^{{5}} (signature or initials and title)", "pdf_field_name": "Vaccinator5 signature or initials and titleInfluenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3_13", "source": "acroform", "row": 0, "col": 7, "rowspan": 2, "colspan": 1, "label_source": "parent_text", "label_ref": "p2.7.8" } } ] }, { "id": "p2.7.9", "order": 46, "type": "table_cell", "bbox": { "l": 42, "t": 634.8960999999999, "r": 358.0984, "b": 548.4001000000001 }, "text": "Lot #\nInfluenza (e.g., IIV3, IIV4, ccIIV3, RIV3, LAIV4)\nGive IIV3, IIV4, ccIIV3, and RIV3 IM. ^{{3}}\nGive LAIV4 NAS. ^{{3}}", "attrs": { "row": 1, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "children": [ { "id": "p2.7.9.1", "order": 47, "type": "form_field", "bbox": { "l": 132.96, "t": 622.44, "r": 206.04, "b": 609.24 }, "text": "", "attrs": { "field_kind": "text", "label": "Type of Vaccine1_Influenza (e.g., IIV3, IIV4, ccIIV3, RIV3, LAIV4) Give IIV3, IIV4, ccIIV3, and RIV3 IM.3 Give LAIV4 NAS.3", "pdf_field_name": "Type of Vaccine1Influenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3", "source": "acroform", "row": 1, "col": 0, "rowspan": 1, "colspan": 1, "text_offset": 15, "text_span": 0 } }, { "id": "p2.7.9.2", "order": 48, "type": "form_field", "bbox": { "l": 207.36, "t": 622.44, "r": 254.28, "b": 609.24 }, "text": "", "attrs": { "field_kind": "text", "label": "mo/day/yr", "pdf_field_name": "Date vaccine given modayyrInfluenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3", "source": "acroform", "row": 1, "col": 0, "rowspan": 1, "colspan": 1, "text_offset": 15, "text_span": 0 } }, { "id": "p2.7.9.3", "order": 49, "type": "form_field", "bbox": { "l": 255.6, "t": 622.44, "r": 289.68, "b": 609.24 }, "text": "", "attrs": { "field_kind": "text", "label": "F,S,P", "pdf_field_name": "Funding Source FSP2Influenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3", "source": "acroform", "row": 1, "col": 0, "rowspan": 1, "colspan": 1, "text_offset": 15, "text_span": 0 } }, { "id": "p2.7.9.4", "order": 50, "type": "form_field", "bbox": { "l": 291, "t": 622.44, "r": 320.16, "b": 609.24 }, "text": "", "attrs": { "field_kind": "text", "label": "Route3 and Site3_Influenza (e.g., IIV3, IIV4, ccIIV3, RIV3, LAIV4) Give IIV3, IIV4, ccIIV3, and RIV3 IM.3 Give LAIV4 NAS.3", "pdf_field_name": "Route3 and Site3Influenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3", "source": "acroform", "row": 1, "col": 0, "rowspan": 1, "colspan": 1, "text_offset": 15, "text_span": 0 } }, { "id": "p2.7.9.5", "order": 51, "type": "form_field", "bbox": { "l": 132.96, "t": 608.52, "r": 206.04, "b": 594.96 }, "text": "", "attrs": { "field_kind": "text", "label": "Type of Vaccine1_Influenza (e.g., IIV3, IIV4, ccIIV3, RIV3, LAIV4) Give IIV3, IIV4, ccIIV3, and RIV3 IM.3 Give LAIV4 NAS.3", "pdf_field_name": "Type of Vaccine1Influenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3_2", "source": "acroform", "row": 1, "col": 0, "rowspan": 1, "colspan": 1, "text_offset": 42, "text_span": 0 } }, { "id": "p2.7.9.6", "order": 52, "type": "form_field", "bbox": { "l": 207.36, "t": 608.52, "r": 254.28, "b": 594.96 }, "text": "", "attrs": { "field_kind": "text", "label": "mo/day/yr", "pdf_field_name": "Date vaccine given modayyrInfluenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3_2", "source": "acroform", "row": 1, "col": 0, "rowspan": 1, "colspan": 1, "text_offset": 80, "text_span": 0 } }, { "id": "p2.7.9.7", "order": 53, "type": "form_field", "bbox": { "l": 255.6, "t": 608.52, "r": 289.68, "b": 594.96 }, "text": "", "attrs": { "field_kind": "text", "label": "F,S,P", "pdf_field_name": "Funding Source FSP2Influenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3_2", "source": "acroform", "row": 1, "col": 0, "rowspan": 1, "colspan": 1, "text_offset": 42, "text_span": 0 } }, { "id": "p2.7.9.8", "order": 54, "type": "form_field", "bbox": { "l": 291, "t": 608.52, "r": 320.16, "b": 594.96 }, "text": "", "attrs": { "field_kind": "text", "label": "Route3 and Site3_Influenza (e.g., IIV3, IIV4, ccIIV3, RIV3, LAIV4) Give IIV3, IIV4, ccIIV3, and RIV3 IM.3 Give LAIV4 NAS.3", "pdf_field_name": "Route3 and Site3Influenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3_2", "source": "acroform", "row": 1, "col": 0, "rowspan": 1, "colspan": 1, "text_offset": 42, "text_span": 0 } }, { "id": "p2.7.9.9", "order": 55, "type": "form_field", "bbox": { "l": 132.96, "t": 594.24, "r": 206.04, "b": 580.68 }, "text": "", "attrs": { "field_kind": "text", "label": "Type of Vaccine1_Influenza (e.g., IIV3, IIV4, ccIIV3, RIV3, LAIV4) Give IIV3, IIV4, ccIIV3, and RIV3 IM.3 Give LAIV4 NAS.3", "pdf_field_name": "Type of Vaccine1Influenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3_3", "source": "acroform", "row": 1, "col": 0, "rowspan": 1, "colspan": 1, "text_offset": 55, "text_span": 0 } }, { "id": "p2.7.9.10", "order": 56, "type": "form_field", "bbox": { "l": 207.36, "t": 594.24, "r": 254.28, "b": 580.68 }, "text": "", "attrs": { "field_kind": "text", "label": "Date vaccine given (mo/day/yr)_Influenza (e.g., IIV3, IIV4, ccIIV3, RIV3, LAIV4) Give IIV3, IIV4, ccIIV3, and RIV3 IM.3 Give LAIV4 NAS.3", "pdf_field_name": "Date vaccine given modayyrInfluenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3_3", "source": "acroform", "row": 1, "col": 0, "rowspan": 1, "colspan": 1, "text_offset": 55, "text_span": 0 } }, { "id": "p2.7.9.11", "order": 57, "type": "form_field", "bbox": { "l": 255.6, "t": 594.24, "r": 289.68, "b": 580.68 }, "text": "", "attrs": { "field_kind": "text", "label": "Funding Source (F,S,P)2_Influenza (e.g., IIV3, IIV4, ccIIV3, RIV3, LAIV4) Give IIV3, IIV4, ccIIV3, and RIV3 IM.3 Give LAIV4 NAS.3", "pdf_field_name": "Funding Source FSP2Influenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3_3", "source": "acroform", "row": 1, "col": 0, "rowspan": 1, "colspan": 1, "text_offset": 55, "text_span": 0 } }, { "id": "p2.7.9.12", "order": 58, "type": "form_field", "bbox": { "l": 291, "t": 594.24, "r": 320.16, "b": 580.68 }, "text": "", "attrs": { "field_kind": "text", "label": "Route3 and Site3_Influenza (e.g., IIV3, IIV4, ccIIV3, RIV3, LAIV4) Give IIV3, IIV4, ccIIV3, and RIV3 IM.3 Give LAIV4 NAS.3", "pdf_field_name": "Route3 and Site3Influenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3_3", "source": "acroform", "row": 1, "col": 0, "rowspan": 1, "colspan": 1, "text_offset": 55, "text_span": 0 } }, { "id": "p2.7.9.13", "order": 59, "type": "form_field", "bbox": { "l": 291, "t": 579.96, "r": 320.16, "b": 566.4 }, "text": "", "attrs": { "field_kind": "text", "label": "Route3 and Site3_Influenza (e.g., IIV3, IIV4, ccIIV3, RIV3, LAIV4) Give IIV3, IIV4, ccIIV3, and RIV3 IM.3 Give LAIV4 NAS.3", "pdf_field_name": "Route3 and Site3Influenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3_4", "source": "acroform", "row": 1, "col": 0, "rowspan": 1, "colspan": 1, "text_offset": 93, "text_span": 0 } }, { "id": "p2.7.9.14", "order": 60, "type": "form_field", "bbox": { "l": 132.96, "t": 565.68, "r": 206.04, "b": 552.24 }, "text": "", "attrs": { "field_kind": "text", "label": "Type of Vaccine1_Influenza (e.g., IIV3, IIV4, ccIIV3, RIV3, LAIV4) Give IIV3, IIV4, ccIIV3, and RIV3 IM.3 Give LAIV4 NAS.3", "pdf_field_name": "Type of Vaccine1Influenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3_5", "source": "acroform", "row": 1, "col": 0, "rowspan": 1, "colspan": 1, "text_offset": 116, "text_span": 0 } }, { "id": "p2.7.9.15", "order": 61, "type": "form_field", "bbox": { "l": 291, "t": 565.68, "r": 320.16, "b": 552.24 }, "text": "", "attrs": { "field_kind": "text", "label": "Route3 and Site3_Influenza (e.g., IIV3, IIV4, ccIIV3, RIV3, LAIV4) Give IIV3, IIV4, ccIIV3, and RIV3 IM.3 Give LAIV4 NAS.3", "pdf_field_name": "Route3 and Site3Influenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3_5", "source": "acroform", "row": 1, "col": 0, "rowspan": 1, "colspan": 1, "text_offset": 116, "text_span": 0 } } ] }, { "id": "p2.7.10", "order": 62, "type": "table_cell", "bbox": { "l": 401.5509, "t": 634.8960999999999, "r": 413.7869, "b": 627.0701 }, "text": "Mfr.", "attrs": { "row": 1, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p2.7.11", "order": 63, "type": "table_cell", "bbox": { "l": 428.9954, "t": 635.1621, "r": 465.7555, "b": 627.3361 }, "text": "Date on VIS ^{{4}}", "attrs": { "row": 1, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p2.7.12", "order": 64, "type": "table_cell", "bbox": { "l": 478.5186, "t": 634.8960999999999, "r": 511.5688, "b": 627.0701 }, "text": "Date given ^{{4}}", "attrs": { "row": 1, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p2.7.13", "order": 65, "type": "table_cell", "bbox": { "l": 35.04, "t": 578.29, "r": 89.256, "b": 561.42 }, "text": "", "attrs": { "row": 2, "col": 0, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.14", "order": 66, "type": "table_cell", "bbox": { "l": 89.256, "t": 578.29, "r": 143.472, "b": 561.42 }, "text": "", "attrs": { "row": 2, "col": 1, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.15", "order": 67, "type": "table_cell", "bbox": { "l": 143.472, "t": 578.29, "r": 197.688, "b": 561.42 }, "text": "", "attrs": { "row": 2, "col": 2, "rowspan": 1, "colspan": 1 }, "children": [ { "id": "p2.7.15.1", "order": 68, "type": "form_field", "bbox": { "l": 132.96, "t": 579.96, "r": 206.04, "b": 566.4 }, "text": "", "attrs": { "field_kind": "text", "label": "Type of Vaccine1_Influenza (e.g., IIV3, IIV4, ccIIV3, RIV3, LAIV4) Give IIV3, IIV4, ccIIV3, and RIV3 IM.3 Give LAIV4 NAS.3", "pdf_field_name": "Type of Vaccine1Influenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3_4", "source": "acroform", "row": 2, "col": 2, "rowspan": 1, "colspan": 1 } } ] }, { "id": "p2.7.16", "order": 69, "type": "table_cell", "bbox": { "l": 197.688, "t": 578.29, "r": 251.904, "b": 561.42 }, "text": "", "attrs": { "row": 2, "col": 3, "rowspan": 1, "colspan": 1 }, "children": [ { "id": "p2.7.16.1", "order": 70, "type": "form_field", "bbox": { "l": 207.36, "t": 579.96, "r": 254.28, "b": 566.4 }, "text": "", "attrs": { "field_kind": "text", "label": "Date vaccine given (mo/day/yr)_Influenza (e.g., IIV3, IIV4, ccIIV3, RIV3, LAIV4) Give IIV3, IIV4, ccIIV3, and RIV3 IM.3 Give LAIV4 NAS.3", "pdf_field_name": "Date vaccine given modayyrInfluenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3_4", "source": "acroform", "row": 2, "col": 3, "rowspan": 1, "colspan": 1 } } ] }, { "id": "p2.7.17", "order": 71, "type": "table_cell", "bbox": { "l": 251.904, "t": 578.29, "r": 306.12, "b": 561.42 }, "text": "", "attrs": { "row": 2, "col": 4, "rowspan": 1, "colspan": 1 }, "children": [ { "id": "p2.7.17.1", "order": 72, "type": "form_field", "bbox": { "l": 255.6, "t": 579.96, "r": 289.68, "b": 566.4 }, "text": "", "attrs": { "field_kind": "text", "label": "Funding Source (F,S,P)2_Influenza (e.g., IIV3, IIV4, ccIIV3, RIV3, LAIV4) Give IIV3, IIV4, ccIIV3, and RIV3 IM.3 Give LAIV4 NAS.3", "pdf_field_name": "Funding Source FSP2Influenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3_4", "source": "acroform", "row": 2, "col": 4, "rowspan": 1, "colspan": 1 } } ] }, { "id": "p2.7.18", "order": 73, "type": "table_cell", "bbox": { "l": 306.12, "t": 578.29, "r": 360.336, "b": 561.42 }, "text": "", "attrs": { "row": 2, "col": 5, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.19", "order": 74, "type": "table_cell", "bbox": { "l": 360.336, "t": 578.29, "r": 414.552, "b": 561.42 }, "text": "", "attrs": { "row": 2, "col": 6, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.20", "order": 75, "type": "table_cell", "bbox": { "l": 414.552, "t": 578.29, "r": 468.768, "b": 561.42 }, "text": "", "attrs": { "row": 2, "col": 7, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.21", "order": 76, "type": "table_cell", "bbox": { "l": 468.768, "t": 578.29, "r": 522.984, "b": 561.42 }, "text": "", "attrs": { "row": 2, "col": 8, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.22", "order": 77, "type": "table_cell", "bbox": { "l": 522.984, "t": 578.29, "r": 577.2, "b": 561.42 }, "text": "", "attrs": { "row": 2, "col": 9, "rowspan": 1, "colspan": 1 }, "children": [ { "id": "p2.7.22.1", "order": 78, "type": "form_field", "bbox": { "l": 519.48, "t": 579.96, "r": 574.92, "b": 566.4 }, "text": "", "attrs": { "field_kind": "text", "label": "Vaccinator5 (signature or initials and title)_Influenza (e.g., IIV3, IIV4, ccIIV3, RIV3, LAIV4) Give IIV3, IIV4, ccIIV3, and RIV3 IM.3 Give LAIV4 NAS.3", "pdf_field_name": "Vaccinator5 signature or initials and titleInfluenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3_4", "source": "acroform", "row": 2, "col": 9, "rowspan": 1, "colspan": 1 } } ] }, { "id": "p2.7.23", "order": 79, "type": "table_cell", "bbox": { "l": 35.04, "t": 561.42, "r": 89.256, "b": 544.55 }, "text": "", "attrs": { "row": 3, "col": 0, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.24", "order": 80, "type": "table_cell", "bbox": { "l": 89.256, "t": 561.42, "r": 143.472, "b": 544.55 }, "text": "", "attrs": { "row": 3, "col": 1, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.25", "order": 81, "type": "table_cell", "bbox": { "l": 143.472, "t": 561.42, "r": 197.688, "b": 544.55 }, "text": "", "attrs": { "row": 3, "col": 2, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.26", "order": 82, "type": "table_cell", "bbox": { "l": 197.688, "t": 561.42, "r": 251.904, "b": 544.55 }, "text": "", "attrs": { "row": 3, "col": 3, "rowspan": 1, "colspan": 1 }, "children": [ { "id": "p2.7.26.1", "order": 83, "type": "form_field", "bbox": { "l": 207.36, "t": 565.68, "r": 254.28, "b": 552.24 }, "text": "", "attrs": { "field_kind": "text", "label": "Date vaccine given (mo/day/yr)_Influenza (e.g., IIV3, IIV4, ccIIV3, RIV3, LAIV4) Give IIV3, IIV4, ccIIV3, and RIV3 IM.3 Give LAIV4 NAS.3", "pdf_field_name": "Date vaccine given modayyrInfluenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3_5", "source": "acroform", "row": 3, "col": 3, "rowspan": 1, "colspan": 1 } } ] }, { "id": "p2.7.27", "order": 84, "type": "table_cell", "bbox": { "l": 251.904, "t": 561.42, "r": 306.12, "b": 544.55 }, "text": "", "attrs": { "row": 3, "col": 4, "rowspan": 1, "colspan": 1 }, "children": [ { "id": "p2.7.27.1", "order": 85, "type": "form_field", "bbox": { "l": 255.6, "t": 565.68, "r": 289.68, "b": 552.24 }, "text": "", "attrs": { "field_kind": "text", "label": "Funding Source (F,S,P)2_Influenza (e.g., IIV3, IIV4, ccIIV3, RIV3, LAIV4) Give IIV3, IIV4, ccIIV3, and RIV3 IM.3 Give LAIV4 NAS.3", "pdf_field_name": "Funding Source FSP2Influenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3_5", "source": "acroform", "row": 3, "col": 4, "rowspan": 1, "colspan": 1 } } ] }, { "id": "p2.7.28", "order": 86, "type": "table_cell", "bbox": { "l": 306.12, "t": 561.42, "r": 360.336, "b": 544.55 }, "text": "", "attrs": { "row": 3, "col": 5, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.29", "order": 87, "type": "table_cell", "bbox": { "l": 360.336, "t": 561.42, "r": 414.552, "b": 544.55 }, "text": "", "attrs": { "row": 3, "col": 6, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.30", "order": 88, "type": "table_cell", "bbox": { "l": 414.552, "t": 561.42, "r": 468.768, "b": 544.55 }, "text": "", "attrs": { "row": 3, "col": 7, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.31", "order": 89, "type": "table_cell", "bbox": { "l": 468.768, "t": 561.42, "r": 522.984, "b": 544.55 }, "text": "", "attrs": { "row": 3, "col": 8, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.32", "order": 90, "type": "table_cell", "bbox": { "l": 522.984, "t": 561.42, "r": 577.2, "b": 544.55 }, "text": "", "attrs": { "row": 3, "col": 9, "rowspan": 1, "colspan": 1 }, "children": [ { "id": "p2.7.32.1", "order": 91, "type": "form_field", "bbox": { "l": 519.48, "t": 565.68, "r": 574.92, "b": 552.24 }, "text": "", "attrs": { "field_kind": "text", "label": "Vaccinator5 (signature or initials and title)_Influenza (e.g., IIV3, IIV4, ccIIV3, RIV3, LAIV4) Give IIV3, IIV4, ccIIV3, and RIV3 IM.3 Give LAIV4 NAS.3", "pdf_field_name": "Vaccinator5 signature or initials and titleInfluenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3_5", "source": "acroform", "row": 3, "col": 9, "rowspan": 1, "colspan": 1 } } ] }, { "id": "p2.7.33", "order": 92, "type": "table_cell", "bbox": { "l": 35.04, "t": 544.55, "r": 89.256, "b": 527.68 }, "text": "", "attrs": { "row": 4, "col": 0, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.34", "order": 93, "type": "table_cell", "bbox": { "l": 89.256, "t": 544.55, "r": 143.472, "b": 527.68 }, "text": "", "attrs": { "row": 4, "col": 1, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.35", "order": 94, "type": "table_cell", "bbox": { "l": 143.472, "t": 544.55, "r": 197.688, "b": 527.68 }, "text": "", "attrs": { "row": 4, "col": 2, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.36", "order": 95, "type": "table_cell", "bbox": { "l": 197.688, "t": 544.55, "r": 251.904, "b": 527.68 }, "text": "", "attrs": { "row": 4, "col": 3, "rowspan": 1, "colspan": 1 }, "children": [ { "id": "p2.7.36.1", "order": 96, "type": "form_field", "bbox": { "l": 207.36, "t": 537.24, "r": 254.28, "b": 523.68 }, "text": "", "attrs": { "field_kind": "text", "label": "Date vaccine given (mo/day/yr)_Influenza (e.g., IIV3, IIV4, ccIIV3, RIV3, LAIV4) Give IIV3, IIV4, ccIIV3, and RIV3 IM.3 Give LAIV4 NAS.3", "pdf_field_name": "Date vaccine given modayyrInfluenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3_7", "source": "acroform", "row": 4, "col": 3, "rowspan": 1, "colspan": 1 } } ] }, { "id": "p2.7.37", "order": 97, "type": "table_cell", "bbox": { "l": 251.904, "t": 544.55, "r": 306.12, "b": 527.68 }, "text": "", "attrs": { "row": 4, "col": 4, "rowspan": 1, "colspan": 1 }, "children": [ { "id": "p2.7.37.1", "order": 98, "type": "form_field", "bbox": { "l": 255.6, "t": 537.24, "r": 289.68, "b": 523.68 }, "text": "", "attrs": { "field_kind": "text", "label": "Funding Source (F,S,P)2_Influenza (e.g., IIV3, IIV4, ccIIV3, RIV3, LAIV4) Give IIV3, IIV4, ccIIV3, and RIV3 IM.3 Give LAIV4 NAS.3", "pdf_field_name": "Funding Source FSP2Influenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3_7", "source": "acroform", "row": 4, "col": 4, "rowspan": 1, "colspan": 1 } } ] }, { "id": "p2.7.38", "order": 99, "type": "table_cell", "bbox": { "l": 306.12, "t": 544.55, "r": 360.336, "b": 527.68 }, "text": "", "attrs": { "row": 4, "col": 5, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.39", "order": 100, "type": "table_cell", "bbox": { "l": 360.336, "t": 544.55, "r": 414.552, "b": 527.68 }, "text": "", "attrs": { "row": 4, "col": 6, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.40", "order": 101, "type": "table_cell", "bbox": { "l": 414.552, "t": 544.55, "r": 468.768, "b": 527.68 }, "text": "", "attrs": { "row": 4, "col": 7, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.41", "order": 102, "type": "table_cell", "bbox": { "l": 468.768, "t": 544.55, "r": 522.984, "b": 527.68 }, "text": "", "attrs": { "row": 4, "col": 8, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.42", "order": 103, "type": "table_cell", "bbox": { "l": 522.984, "t": 544.55, "r": 577.2, "b": 527.68 }, "text": "", "attrs": { "row": 4, "col": 9, "rowspan": 1, "colspan": 1 }, "children": [ { "id": "p2.7.42.1", "order": 104, "type": "form_field", "bbox": { "l": 519.48, "t": 537.24, "r": 574.92, "b": 523.68 }, "text": "", "attrs": { "field_kind": "text", "label": "Vaccinator5 (signature or initials and title)_Influenza (e.g., IIV3, IIV4, ccIIV3, RIV3, LAIV4) Give IIV3, IIV4, ccIIV3, and RIV3 IM.3 Give LAIV4 NAS.3", "pdf_field_name": "Vaccinator5 signature or initials and titleInfluenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3_7", "source": "acroform", "row": 4, "col": 9, "rowspan": 1, "colspan": 1 } } ] }, { "id": "p2.7.43", "order": 105, "type": "table_cell", "bbox": { "l": 35.04, "t": 527.68, "r": 89.256, "b": 510.81 }, "text": "", "attrs": { "row": 5, "col": 0, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.44", "order": 106, "type": "table_cell", "bbox": { "l": 89.256, "t": 527.68, "r": 143.472, "b": 510.81 }, "text": "", "attrs": { "row": 5, "col": 1, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.45", "order": 107, "type": "table_cell", "bbox": { "l": 143.472, "t": 527.68, "r": 197.688, "b": 510.81 }, "text": "", "attrs": { "row": 5, "col": 2, "rowspan": 1, "colspan": 1 }, "children": [ { "id": "p2.7.45.1", "order": 108, "type": "form_field", "bbox": { "l": 132.96, "t": 522.96, "r": 206.04, "b": 509.4 }, "text": "", "attrs": { "field_kind": "text", "label": "Type of Vaccine1_Influenza (e.g., IIV3, IIV4, ccIIV3, RIV3, LAIV4) Give IIV3, IIV4, ccIIV3, and RIV3 IM.3 Give LAIV4 NAS.3", "pdf_field_name": "Type of Vaccine1Influenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3_8", "source": "acroform", "row": 5, "col": 2, "rowspan": 1, "colspan": 1 } } ] }, { "id": "p2.7.46", "order": 109, "type": "table_cell", "bbox": { "l": 197.688, "t": 527.68, "r": 251.904, "b": 510.81 }, "text": "", "attrs": { "row": 5, "col": 3, "rowspan": 1, "colspan": 1 }, "children": [ { "id": "p2.7.46.1", "order": 110, "type": "form_field", "bbox": { "l": 207.36, "t": 522.96, "r": 254.28, "b": 509.4 }, "text": "", "attrs": { "field_kind": "text", "label": "Date vaccine given (mo/day/yr)_Influenza (e.g., IIV3, IIV4, ccIIV3, RIV3, LAIV4) Give IIV3, IIV4, ccIIV3, and RIV3 IM.3 Give LAIV4 NAS.3", "pdf_field_name": "Date vaccine given modayyrInfluenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3_8", "source": "acroform", "row": 5, "col": 3, "rowspan": 1, "colspan": 1 } } ] }, { "id": "p2.7.47", "order": 111, "type": "table_cell", "bbox": { "l": 251.904, "t": 527.68, "r": 306.12, "b": 510.81 }, "text": "", "attrs": { "row": 5, "col": 4, "rowspan": 1, "colspan": 1 }, "children": [ { "id": "p2.7.47.1", "order": 112, "type": "form_field", "bbox": { "l": 255.6, "t": 522.96, "r": 289.68, "b": 509.4 }, "text": "", "attrs": { "field_kind": "text", "label": "Funding Source (F,S,P)2_Influenza (e.g., IIV3, IIV4, ccIIV3, RIV3, LAIV4) Give IIV3, IIV4, ccIIV3, and RIV3 IM.3 Give LAIV4 NAS.3", "pdf_field_name": "Funding Source FSP2Influenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3_8", "source": "acroform", "row": 5, "col": 4, "rowspan": 1, "colspan": 1 } } ] }, { "id": "p2.7.48", "order": 113, "type": "table_cell", "bbox": { "l": 306.12, "t": 527.68, "r": 360.336, "b": 510.81 }, "text": "", "attrs": { "row": 5, "col": 5, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.49", "order": 114, "type": "table_cell", "bbox": { "l": 360.336, "t": 527.68, "r": 414.552, "b": 510.81 }, "text": "", "attrs": { "row": 5, "col": 6, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.50", "order": 115, "type": "table_cell", "bbox": { "l": 414.552, "t": 527.68, "r": 468.768, "b": 510.81 }, "text": "", "attrs": { "row": 5, "col": 7, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.51", "order": 116, "type": "table_cell", "bbox": { "l": 468.768, "t": 527.68, "r": 522.984, "b": 510.81 }, "text": "", "attrs": { "row": 5, "col": 8, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.52", "order": 117, "type": "table_cell", "bbox": { "l": 522.984, "t": 527.68, "r": 577.2, "b": 510.81 }, "text": "", "attrs": { "row": 5, "col": 9, "rowspan": 1, "colspan": 1 }, "children": [ { "id": "p2.7.52.1", "order": 118, "type": "form_field", "bbox": { "l": 519.48, "t": 522.96, "r": 574.92, "b": 509.4 }, "text": "", "attrs": { "field_kind": "text", "label": "Vaccinator5 (signature or initials and title)_Influenza (e.g., IIV3, IIV4, ccIIV3, RIV3, LAIV4) Give IIV3, IIV4, ccIIV3, and RIV3 IM.3 Give LAIV4 NAS.3", "pdf_field_name": "Vaccinator5 signature or initials and titleInfluenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3_8", "source": "acroform", "row": 5, "col": 9, "rowspan": 1, "colspan": 1 } } ] }, { "id": "p2.7.53", "order": 119, "type": "table_cell", "bbox": { "l": 35.04, "t": 510.81, "r": 89.256, "b": 493.94 }, "text": "", "attrs": { "row": 6, "col": 0, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.54", "order": 120, "type": "table_cell", "bbox": { "l": 89.256, "t": 510.81, "r": 143.472, "b": 493.94 }, "text": "", "attrs": { "row": 6, "col": 1, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.55", "order": 121, "type": "table_cell", "bbox": { "l": 143.472, "t": 510.81, "r": 197.688, "b": 493.94 }, "text": "", "attrs": { "row": 6, "col": 2, "rowspan": 1, "colspan": 1 }, "children": [ { "id": "p2.7.55.1", "order": 122, "type": "form_field", "bbox": { "l": 132.96, "t": 508.68, "r": 206.04, "b": 495.24 }, "text": "", "attrs": { "field_kind": "text", "label": "Type of Vaccine1_Influenza (e.g., IIV3, IIV4, ccIIV3, RIV3, LAIV4) Give IIV3, IIV4, ccIIV3, and RIV3 IM.3 Give LAIV4 NAS.3", "pdf_field_name": "Type of Vaccine1Influenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3_9", "source": "acroform", "row": 6, "col": 2, "rowspan": 1, "colspan": 1 } } ] }, { "id": "p2.7.56", "order": 123, "type": "table_cell", "bbox": { "l": 197.688, "t": 510.81, "r": 251.904, "b": 493.94 }, "text": "", "attrs": { "row": 6, "col": 3, "rowspan": 1, "colspan": 1 }, "children": [ { "id": "p2.7.56.1", "order": 124, "type": "form_field", "bbox": { "l": 207.36, "t": 508.68, "r": 254.28, "b": 495.24 }, "text": "", "attrs": { "field_kind": "text", "label": "Date vaccine given (mo/day/yr)_Influenza (e.g., IIV3, IIV4, ccIIV3, RIV3, LAIV4) Give IIV3, IIV4, ccIIV3, and RIV3 IM.3 Give LAIV4 NAS.3", "pdf_field_name": "Date vaccine given modayyrInfluenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3_9", "source": "acroform", "row": 6, "col": 3, "rowspan": 1, "colspan": 1 } } ] }, { "id": "p2.7.57", "order": 125, "type": "table_cell", "bbox": { "l": 251.904, "t": 510.81, "r": 306.12, "b": 493.94 }, "text": "", "attrs": { "row": 6, "col": 4, "rowspan": 1, "colspan": 1 }, "children": [ { "id": "p2.7.57.1", "order": 126, "type": "form_field", "bbox": { "l": 255.6, "t": 508.68, "r": 289.68, "b": 495.24 }, "text": "", "attrs": { "field_kind": "text", "label": "Funding Source (F,S,P)2_Influenza (e.g., IIV3, IIV4, ccIIV3, RIV3, LAIV4) Give IIV3, IIV4, ccIIV3, and RIV3 IM.3 Give LAIV4 NAS.3", "pdf_field_name": "Funding Source FSP2Influenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3_9", "source": "acroform", "row": 6, "col": 4, "rowspan": 1, "colspan": 1 } } ] }, { "id": "p2.7.58", "order": 127, "type": "table_cell", "bbox": { "l": 306.12, "t": 510.81, "r": 360.336, "b": 493.94 }, "text": "", "attrs": { "row": 6, "col": 5, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.59", "order": 128, "type": "table_cell", "bbox": { "l": 360.336, "t": 510.81, "r": 414.552, "b": 493.94 }, "text": "", "attrs": { "row": 6, "col": 6, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.60", "order": 129, "type": "table_cell", "bbox": { "l": 414.552, "t": 510.81, "r": 468.768, "b": 493.94 }, "text": "", "attrs": { "row": 6, "col": 7, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.61", "order": 130, "type": "table_cell", "bbox": { "l": 468.768, "t": 510.81, "r": 522.984, "b": 493.94 }, "text": "", "attrs": { "row": 6, "col": 8, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.62", "order": 131, "type": "table_cell", "bbox": { "l": 522.984, "t": 510.81, "r": 577.2, "b": 493.94 }, "text": "", "attrs": { "row": 6, "col": 9, "rowspan": 1, "colspan": 1 }, "children": [ { "id": "p2.7.62.1", "order": 132, "type": "form_field", "bbox": { "l": 519.48, "t": 508.68, "r": 574.92, "b": 495.24 }, "text": "", "attrs": { "field_kind": "text", "label": "Vaccinator5 (signature or initials and title)_Influenza (e.g., IIV3, IIV4, ccIIV3, RIV3, LAIV4) Give IIV3, IIV4, ccIIV3, and RIV3 IM.3 Give LAIV4 NAS.3", "pdf_field_name": "Vaccinator5 signature or initials and titleInfluenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3_9", "source": "acroform", "row": 6, "col": 9, "rowspan": 1, "colspan": 1 } } ] }, { "id": "p2.7.63", "order": 133, "type": "table_cell", "bbox": { "l": 35.04, "t": 493.94, "r": 89.256, "b": 477.07 }, "text": "", "attrs": { "row": 7, "col": 0, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.64", "order": 134, "type": "table_cell", "bbox": { "l": 89.256, "t": 493.94, "r": 143.472, "b": 477.07 }, "text": "", "attrs": { "row": 7, "col": 1, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.65", "order": 135, "type": "table_cell", "bbox": { "l": 143.472, "t": 493.94, "r": 197.688, "b": 477.07 }, "text": "", "attrs": { "row": 7, "col": 2, "rowspan": 1, "colspan": 1 }, "children": [ { "id": "p2.7.65.1", "order": 136, "type": "form_field", "bbox": { "l": 132.96, "t": 494.52, "r": 206.04, "b": 480.96 }, "text": "", "attrs": { "field_kind": "text", "label": "Type of Vaccine1_Influenza (e.g., IIV3, IIV4, ccIIV3, RIV3, LAIV4) Give IIV3, IIV4, ccIIV3, and RIV3 IM.3 Give LAIV4 NAS.3", "pdf_field_name": "Type of Vaccine1Influenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3_10", "source": "acroform", "row": 7, "col": 2, "rowspan": 1, "colspan": 1 } } ] }, { "id": "p2.7.66", "order": 137, "type": "table_cell", "bbox": { "l": 197.688, "t": 493.94, "r": 251.904, "b": 477.07 }, "text": "", "attrs": { "row": 7, "col": 3, "rowspan": 1, "colspan": 1 }, "children": [ { "id": "p2.7.66.1", "order": 138, "type": "form_field", "bbox": { "l": 207.36, "t": 494.52, "r": 254.28, "b": 480.96 }, "text": "", "attrs": { "field_kind": "text", "label": "Date vaccine given (mo/day/yr)_Influenza (e.g., IIV3, IIV4, ccIIV3, RIV3, LAIV4) Give IIV3, IIV4, ccIIV3, and RIV3 IM.3 Give LAIV4 NAS.3", "pdf_field_name": "Date vaccine given modayyrInfluenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3_10", "source": "acroform", "row": 7, "col": 3, "rowspan": 1, "colspan": 1 } } ] }, { "id": "p2.7.67", "order": 139, "type": "table_cell", "bbox": { "l": 251.904, "t": 493.94, "r": 306.12, "b": 477.07 }, "text": "", "attrs": { "row": 7, "col": 4, "rowspan": 1, "colspan": 1 }, "children": [ { "id": "p2.7.67.1", "order": 140, "type": "form_field", "bbox": { "l": 255.6, "t": 494.52, "r": 289.68, "b": 480.96 }, "text": "", "attrs": { "field_kind": "text", "label": "Funding Source (F,S,P)2_Influenza (e.g., IIV3, IIV4, ccIIV3, RIV3, LAIV4) Give IIV3, IIV4, ccIIV3, and RIV3 IM.3 Give LAIV4 NAS.3", "pdf_field_name": "Funding Source FSP2Influenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3_10", "source": "acroform", "row": 7, "col": 4, "rowspan": 1, "colspan": 1 } } ] }, { "id": "p2.7.68", "order": 141, "type": "table_cell", "bbox": { "l": 306.12, "t": 493.94, "r": 360.336, "b": 477.07 }, "text": "", "attrs": { "row": 7, "col": 5, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.69", "order": 142, "type": "table_cell", "bbox": { "l": 360.336, "t": 493.94, "r": 414.552, "b": 477.07 }, "text": "", "attrs": { "row": 7, "col": 6, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.70", "order": 143, "type": "table_cell", "bbox": { "l": 414.552, "t": 493.94, "r": 468.768, "b": 477.07 }, "text": "", "attrs": { "row": 7, "col": 7, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.71", "order": 144, "type": "table_cell", "bbox": { "l": 468.768, "t": 493.94, "r": 522.984, "b": 477.07 }, "text": "", "attrs": { "row": 7, "col": 8, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.72", "order": 145, "type": "table_cell", "bbox": { "l": 522.984, "t": 493.94, "r": 577.2, "b": 477.07 }, "text": "", "attrs": { "row": 7, "col": 9, "rowspan": 1, "colspan": 1 }, "children": [ { "id": "p2.7.72.1", "order": 146, "type": "form_field", "bbox": { "l": 519.48, "t": 494.52, "r": 574.92, "b": 480.96 }, "text": "", "attrs": { "field_kind": "text", "label": "Vaccinator5 (signature or initials and title)_Influenza (e.g., IIV3, IIV4, ccIIV3, RIV3, LAIV4) Give IIV3, IIV4, ccIIV3, and RIV3 IM.3 Give LAIV4 NAS.3", "pdf_field_name": "Vaccinator5 signature or initials and titleInfluenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3_10", "source": "acroform", "row": 7, "col": 9, "rowspan": 1, "colspan": 1 } } ] }, { "id": "p2.7.73", "order": 147, "type": "table_cell", "bbox": { "l": 35.04, "t": 477.07, "r": 89.256, "b": 460.2 }, "text": "", "attrs": { "row": 8, "col": 0, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.74", "order": 148, "type": "table_cell", "bbox": { "l": 89.256, "t": 477.07, "r": 143.472, "b": 460.2 }, "text": "", "attrs": { "row": 8, "col": 1, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.75", "order": 149, "type": "table_cell", "bbox": { "l": 143.472, "t": 477.07, "r": 197.688, "b": 460.2 }, "text": "", "attrs": { "row": 8, "col": 2, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.76", "order": 150, "type": "table_cell", "bbox": { "l": 197.688, "t": 477.07, "r": 251.904, "b": 460.2 }, "text": "", "attrs": { "row": 8, "col": 3, "rowspan": 1, "colspan": 1 }, "children": [ { "id": "p2.7.76.1", "order": 151, "type": "form_field", "bbox": { "l": 207.36, "t": 480.24, "r": 254.28, "b": 466.68 }, "text": "", "attrs": { "field_kind": "text", "label": "Date vaccine given (mo/day/yr)_Influenza (e.g., IIV3, IIV4, ccIIV3, RIV3, LAIV4) Give IIV3, IIV4, ccIIV3, and RIV3 IM.3 Give LAIV4 NAS.3", "pdf_field_name": "Date vaccine given modayyrInfluenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3_11", "source": "acroform", "row": 8, "col": 3, "rowspan": 1, "colspan": 1 } } ] }, { "id": "p2.7.77", "order": 152, "type": "table_cell", "bbox": { "l": 251.904, "t": 477.07, "r": 306.12, "b": 460.2 }, "text": "", "attrs": { "row": 8, "col": 4, "rowspan": 1, "colspan": 1 }, "children": [ { "id": "p2.7.77.1", "order": 153, "type": "form_field", "bbox": { "l": 255.6, "t": 480.24, "r": 289.68, "b": 466.68 }, "text": "", "attrs": { "field_kind": "text", "label": "Funding Source (F,S,P)2_Influenza (e.g., IIV3, IIV4, ccIIV3, RIV3, LAIV4) Give IIV3, IIV4, ccIIV3, and RIV3 IM.3 Give LAIV4 NAS.3", "pdf_field_name": "Funding Source FSP2Influenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3_11", "source": "acroform", "row": 8, "col": 4, "rowspan": 1, "colspan": 1 } } ] }, { "id": "p2.7.78", "order": 154, "type": "table_cell", "bbox": { "l": 306.12, "t": 477.07, "r": 360.336, "b": 460.2 }, "text": "", "attrs": { "row": 8, "col": 5, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.79", "order": 155, "type": "table_cell", "bbox": { "l": 360.336, "t": 477.07, "r": 414.552, "b": 460.2 }, "text": "", "attrs": { "row": 8, "col": 6, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.80", "order": 156, "type": "table_cell", "bbox": { "l": 414.552, "t": 477.07, "r": 468.768, "b": 460.2 }, "text": "", "attrs": { "row": 8, "col": 7, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.81", "order": 157, "type": "table_cell", "bbox": { "l": 468.768, "t": 477.07, "r": 522.984, "b": 460.2 }, "text": "", "attrs": { "row": 8, "col": 8, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.82", "order": 158, "type": "table_cell", "bbox": { "l": 522.984, "t": 477.07, "r": 577.2, "b": 460.2 }, "text": "", "attrs": { "row": 8, "col": 9, "rowspan": 1, "colspan": 1 }, "children": [ { "id": "p2.7.82.1", "order": 159, "type": "form_field", "bbox": { "l": 519.48, "t": 480.24, "r": 574.92, "b": 466.68 }, "text": "", "attrs": { "field_kind": "text", "label": "Vaccinator5 (signature or initials and title)_Influenza (e.g., IIV3, IIV4, ccIIV3, RIV3, LAIV4) Give IIV3, IIV4, ccIIV3, and RIV3 IM.3 Give LAIV4 NAS.3", "pdf_field_name": "Vaccinator5 signature or initials and titleInfluenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3_11", "source": "acroform", "row": 8, "col": 9, "rowspan": 1, "colspan": 1 } } ] }, { "id": "p2.7.83", "order": 160, "type": "table_cell", "bbox": { "l": 35.04, "t": 460.2, "r": 89.256, "b": 443.33 }, "text": "", "attrs": { "row": 9, "col": 0, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.84", "order": 161, "type": "table_cell", "bbox": { "l": 89.256, "t": 460.2, "r": 143.472, "b": 443.33 }, "text": "", "attrs": { "row": 9, "col": 1, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.85", "order": 162, "type": "table_cell", "bbox": { "l": 143.472, "t": 460.2, "r": 197.688, "b": 443.33 }, "text": "", "attrs": { "row": 9, "col": 2, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.86", "order": 163, "type": "table_cell", "bbox": { "l": 197.688, "t": 460.2, "r": 251.904, "b": 443.33 }, "text": "", "attrs": { "row": 9, "col": 3, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.87", "order": 164, "type": "table_cell", "bbox": { "l": 251.904, "t": 460.2, "r": 306.12, "b": 443.33 }, "text": "", "attrs": { "row": 9, "col": 4, "rowspan": 1, "colspan": 1 }, "children": [ { "id": "p2.7.87.1", "order": 165, "type": "form_field", "bbox": { "l": 255.6, "t": 451.68, "r": 289.68, "b": 438.24 }, "text": "", "attrs": { "field_kind": "text", "label": "Funding Source (F,S,P)2_Influenza (e.g., IIV3, IIV4, ccIIV3, RIV3, LAIV4) Give IIV3, IIV4, ccIIV3, and RIV3 IM.3 Give LAIV4 NAS.3", "pdf_field_name": "Funding Source FSP2Influenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3_13", "source": "acroform", "row": 9, "col": 4, "rowspan": 1, "colspan": 1 } } ] }, { "id": "p2.7.88", "order": 166, "type": "table_cell", "bbox": { "l": 306.12, "t": 460.2, "r": 360.336, "b": 443.33 }, "text": "", "attrs": { "row": 9, "col": 5, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.89", "order": 167, "type": "table_cell", "bbox": { "l": 360.336, "t": 460.2, "r": 414.552, "b": 443.33 }, "text": "", "attrs": { "row": 9, "col": 6, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.90", "order": 168, "type": "table_cell", "bbox": { "l": 414.552, "t": 460.2, "r": 468.768, "b": 443.33 }, "text": "", "attrs": { "row": 9, "col": 7, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.91", "order": 169, "type": "table_cell", "bbox": { "l": 468.768, "t": 460.2, "r": 522.984, "b": 443.33 }, "text": "", "attrs": { "row": 9, "col": 8, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.92", "order": 170, "type": "table_cell", "bbox": { "l": 522.984, "t": 460.2, "r": 577.2, "b": 443.33 }, "text": "", "attrs": { "row": 9, "col": 9, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.93", "order": 171, "type": "table_cell", "bbox": { "l": 35.04, "t": 443.33, "r": 89.256, "b": 426.46 }, "text": "", "attrs": { "row": 10, "col": 0, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.94", "order": 172, "type": "table_cell", "bbox": { "l": 89.256, "t": 443.33, "r": 143.472, "b": 426.46 }, "text": "", "attrs": { "row": 10, "col": 1, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.95", "order": 173, "type": "table_cell", "bbox": { "l": 143.472, "t": 443.33, "r": 197.688, "b": 426.46 }, "text": "", "attrs": { "row": 10, "col": 2, "rowspan": 1, "colspan": 1 }, "children": [ { "id": "p2.7.95.1", "order": 174, "type": "form_field", "bbox": { "l": 132.96, "t": 437.52, "r": 206.04, "b": 423.96 }, "text": "", "attrs": { "field_kind": "text", "label": "Type of Vaccine1_Influenza (e.g., IIV3, IIV4, ccIIV3, RIV3, LAIV4) Give IIV3, IIV4, ccIIV3, and RIV3 IM.3 Give LAIV4 NAS.3", "pdf_field_name": "Type of Vaccine1Influenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3_14", "source": "acroform", "row": 10, "col": 2, "rowspan": 1, "colspan": 1 } } ] }, { "id": "p2.7.96", "order": 175, "type": "table_cell", "bbox": { "l": 197.688, "t": 443.33, "r": 251.904, "b": 426.46 }, "text": "", "attrs": { "row": 10, "col": 3, "rowspan": 1, "colspan": 1 }, "children": [ { "id": "p2.7.96.1", "order": 176, "type": "form_field", "bbox": { "l": 207.36, "t": 437.52, "r": 254.28, "b": 423.96 }, "text": "", "attrs": { "field_kind": "text", "label": "Date vaccine given (mo/day/yr)_Influenza (e.g., IIV3, IIV4, ccIIV3, RIV3, LAIV4) Give IIV3, IIV4, ccIIV3, and RIV3 IM.3 Give LAIV4 NAS.3", "pdf_field_name": "Date vaccine given modayyrInfluenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3_14", "source": "acroform", "row": 10, "col": 3, "rowspan": 1, "colspan": 1 } } ] }, { "id": "p2.7.97", "order": 177, "type": "table_cell", "bbox": { "l": 251.904, "t": 443.33, "r": 306.12, "b": 426.46 }, "text": "", "attrs": { "row": 10, "col": 4, "rowspan": 1, "colspan": 1 }, "children": [ { "id": "p2.7.97.1", "order": 178, "type": "form_field", "bbox": { "l": 255.6, "t": 437.52, "r": 289.68, "b": 423.96 }, "text": "", "attrs": { "field_kind": "text", "label": "Funding Source (F,S,P)2_Influenza (e.g., IIV3, IIV4, ccIIV3, RIV3, LAIV4) Give IIV3, IIV4, ccIIV3, and RIV3 IM.3 Give LAIV4 NAS.3", "pdf_field_name": "Funding Source FSP2Influenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3_14", "source": "acroform", "row": 10, "col": 4, "rowspan": 1, "colspan": 1 } } ] }, { "id": "p2.7.98", "order": 179, "type": "table_cell", "bbox": { "l": 306.12, "t": 443.33, "r": 360.336, "b": 426.46 }, "text": "", "attrs": { "row": 10, "col": 5, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.99", "order": 180, "type": "table_cell", "bbox": { "l": 360.336, "t": 443.33, "r": 414.552, "b": 426.46 }, "text": "", "attrs": { "row": 10, "col": 6, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.100", "order": 181, "type": "table_cell", "bbox": { "l": 414.552, "t": 443.33, "r": 468.768, "b": 426.46 }, "text": "", "attrs": { "row": 10, "col": 7, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.101", "order": 182, "type": "table_cell", "bbox": { "l": 468.768, "t": 443.33, "r": 522.984, "b": 426.46 }, "text": "", "attrs": { "row": 10, "col": 8, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.102", "order": 183, "type": "table_cell", "bbox": { "l": 522.984, "t": 443.33, "r": 577.2, "b": 426.46 }, "text": "", "attrs": { "row": 10, "col": 9, "rowspan": 1, "colspan": 1 }, "children": [ { "id": "p2.7.102.1", "order": 184, "type": "form_field", "bbox": { "l": 519.48, "t": 437.52, "r": 574.92, "b": 423.96 }, "text": "", "attrs": { "field_kind": "text", "label": "Vaccinator5 (signature or initials and title)_Influenza (e.g., IIV3, IIV4, ccIIV3, RIV3, LAIV4) Give IIV3, IIV4, ccIIV3, and RIV3 IM.3 Give LAIV4 NAS.3", "pdf_field_name": "Vaccinator5 signature or initials and titleInfluenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3_14", "source": "acroform", "row": 10, "col": 9, "rowspan": 1, "colspan": 1 } } ] }, { "id": "p2.7.103", "order": 185, "type": "table_cell", "bbox": { "l": 35.04, "t": 426.46, "r": 89.256, "b": 409.59 }, "text": "", "attrs": { "row": 11, "col": 0, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.104", "order": 186, "type": "table_cell", "bbox": { "l": 89.256, "t": 426.46, "r": 143.472, "b": 409.59 }, "text": "", "attrs": { "row": 11, "col": 1, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.105", "order": 187, "type": "table_cell", "bbox": { "l": 143.472, "t": 426.46, "r": 197.688, "b": 409.59 }, "text": "", "attrs": { "row": 11, "col": 2, "rowspan": 1, "colspan": 1 }, "children": [ { "id": "p2.7.105.1", "order": 188, "type": "form_field", "bbox": { "l": 132.96, "t": 423.24, "r": 206.04, "b": 410.04 }, "text": "", "attrs": { "field_kind": "text", "label": "Type of Vaccine1_Influenza (e.g., IIV3, IIV4, ccIIV3, RIV3, LAIV4) Give IIV3, IIV4, ccIIV3, and RIV3 IM.3 Give LAIV4 NAS.3", "pdf_field_name": "Type of Vaccine1Influenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3_15", "source": "acroform", "row": 11, "col": 2, "rowspan": 1, "colspan": 1 } } ] }, { "id": "p2.7.106", "order": 189, "type": "table_cell", "bbox": { "l": 197.688, "t": 426.46, "r": 251.904, "b": 409.59 }, "text": "", "attrs": { "row": 11, "col": 3, "rowspan": 1, "colspan": 1 }, "children": [ { "id": "p2.7.106.1", "order": 190, "type": "form_field", "bbox": { "l": 207.36, "t": 423.24, "r": 254.28, "b": 410.04 }, "text": "", "attrs": { "field_kind": "text", "label": "Date vaccine given (mo/day/yr)_Influenza (e.g., IIV3, IIV4, ccIIV3, RIV3, LAIV4) Give IIV3, IIV4, ccIIV3, and RIV3 IM.3 Give LAIV4 NAS.3", "pdf_field_name": "Date vaccine given modayyrInfluenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3_15", "source": "acroform", "row": 11, "col": 3, "rowspan": 1, "colspan": 1 } } ] }, { "id": "p2.7.107", "order": 191, "type": "table_cell", "bbox": { "l": 251.904, "t": 426.46, "r": 306.12, "b": 409.59 }, "text": "", "attrs": { "row": 11, "col": 4, "rowspan": 1, "colspan": 1 }, "children": [ { "id": "p2.7.107.1", "order": 192, "type": "form_field", "bbox": { "l": 255.6, "t": 423.24, "r": 289.68, "b": 410.04 }, "text": "", "attrs": { "field_kind": "text", "label": "Funding Source (F,S,P)2_Influenza (e.g., IIV3, IIV4, ccIIV3, RIV3, LAIV4) Give IIV3, IIV4, ccIIV3, and RIV3 IM.3 Give LAIV4 NAS.3", "pdf_field_name": "Funding Source FSP2Influenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3_15", "source": "acroform", "row": 11, "col": 4, "rowspan": 1, "colspan": 1 } } ] }, { "id": "p2.7.108", "order": 193, "type": "table_cell", "bbox": { "l": 306.12, "t": 426.46, "r": 360.336, "b": 409.59 }, "text": "", "attrs": { "row": 11, "col": 5, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.109", "order": 194, "type": "table_cell", "bbox": { "l": 360.336, "t": 426.46, "r": 414.552, "b": 409.59 }, "text": "", "attrs": { "row": 11, "col": 6, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.110", "order": 195, "type": "table_cell", "bbox": { "l": 414.552, "t": 426.46, "r": 468.768, "b": 409.59 }, "text": "", "attrs": { "row": 11, "col": 7, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.111", "order": 196, "type": "table_cell", "bbox": { "l": 468.768, "t": 426.46, "r": 522.984, "b": 409.59 }, "text": "", "attrs": { "row": 11, "col": 8, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.112", "order": 197, "type": "table_cell", "bbox": { "l": 522.984, "t": 426.46, "r": 577.2, "b": 409.59 }, "text": "", "attrs": { "row": 11, "col": 9, "rowspan": 1, "colspan": 1 }, "children": [ { "id": "p2.7.112.1", "order": 198, "type": "form_field", "bbox": { "l": 519.48, "t": 423.24, "r": 574.92, "b": 410.04 }, "text": "", "attrs": { "field_kind": "text", "label": "Vaccinator5 (signature or initials and title)_Influenza (e.g., IIV3, IIV4, ccIIV3, RIV3, LAIV4) Give IIV3, IIV4, ccIIV3, and RIV3 IM.3 Give LAIV4 NAS.3", "pdf_field_name": "Vaccinator5 signature or initials and titleInfluenza eg IIV3 IIV4 ccIIV3 RIV3 LAIV4 Give IIV3 IIV4 ccIIV3 and RIV3 IM3 Give LAIV4 NAS3_15", "source": "acroform", "row": 11, "col": 9, "rowspan": 1, "colspan": 1 } } ] }, { "id": "p2.7.113", "order": 199, "type": "table_cell", "bbox": { "l": 35.04, "t": 409.59, "r": 89.256, "b": 392.72 }, "text": "", "attrs": { "row": 12, "col": 0, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.114", "order": 200, "type": "table_cell", "bbox": { "l": 89.256, "t": 409.59, "r": 143.472, "b": 392.72 }, "text": "", "attrs": { "row": 12, "col": 1, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.115", "order": 201, "type": "table_cell", "bbox": { "l": 143.472, "t": 409.59, "r": 197.688, "b": 392.72 }, "text": "", "attrs": { "row": 12, "col": 2, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.116", "order": 202, "type": "table_cell", "bbox": { "l": 197.688, "t": 409.59, "r": 251.904, "b": 392.72 }, "text": "", "attrs": { "row": 12, "col": 3, "rowspan": 1, "colspan": 1 }, "children": [ { "id": "p2.7.116.1", "order": 203, "type": "form_field", "bbox": { "l": 207.6, "t": 408.6, "r": 254.04, "b": 387.72 }, "text": "", "attrs": { "field_kind": "text", "pdf_field_name": "undefined", "source": "acroform", "row": 12, "col": 3, "rowspan": 1, "colspan": 1 } } ] }, { "id": "p2.7.117", "order": 204, "type": "table_cell", "bbox": { "l": 251.904, "t": 409.59, "r": 306.12, "b": 392.72 }, "text": "", "attrs": { "row": 12, "col": 4, "rowspan": 1, "colspan": 1 }, "children": [ { "id": "p2.7.117.1", "order": 205, "type": "form_field", "bbox": { "l": 255.84, "t": 408.6, "r": 289.44, "b": 387.72 }, "text": "", "attrs": { "field_kind": "text", "pdf_field_name": "undefined_2", "source": "acroform", "row": 12, "col": 4, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.117.2", "order": 206, "type": "form_field", "bbox": { "l": 291.24, "t": 408.6, "r": 319.92, "b": 387.72 }, "text": "", "attrs": { "field_kind": "text", "pdf_field_name": "undefined_3", "source": "acroform", "row": 12, "col": 4, "rowspan": 1, "colspan": 1 } } ] }, { "id": "p2.7.118", "order": 207, "type": "table_cell", "bbox": { "l": 306.12, "t": 409.59, "r": 360.336, "b": 392.72 }, "text": "", "attrs": { "row": 12, "col": 5, "rowspan": 1, "colspan": 1 }, "children": [ { "id": "p2.7.118.1", "order": 208, "type": "form_field", "bbox": { "l": 321.72, "t": 408.6, "r": 391.56, "b": 387.72 }, "text": "", "attrs": { "field_kind": "text", "pdf_field_name": "undefined_4", "source": "acroform", "row": 12, "col": 5, "rowspan": 1, "colspan": 1 } } ] }, { "id": "p2.7.119", "order": 209, "type": "table_cell", "bbox": { "l": 360.336, "t": 409.59, "r": 414.552, "b": 392.72 }, "text": "", "attrs": { "row": 12, "col": 6, "rowspan": 1, "colspan": 1 }, "children": [ { "id": "p2.7.119.1", "order": 210, "type": "form_field", "bbox": { "l": 393.12, "t": 408.6, "r": 422.04, "b": 387.72 }, "text": "", "attrs": { "field_kind": "text", "pdf_field_name": "undefined_5", "source": "acroform", "row": 12, "col": 6, "rowspan": 1, "colspan": 1 } } ] }, { "id": "p2.7.120", "order": 211, "type": "table_cell", "bbox": { "l": 414.552, "t": 409.59, "r": 468.768, "b": 392.72 }, "text": "", "attrs": { "row": 12, "col": 7, "rowspan": 1, "colspan": 1 }, "children": [ { "id": "p2.7.120.1", "order": 212, "type": "form_field", "bbox": { "l": 423.84, "t": 408.6, "r": 471.36, "b": 387.72 }, "text": "", "attrs": { "field_kind": "text", "pdf_field_name": "undefined_6", "source": "acroform", "row": 12, "col": 7, "rowspan": 1, "colspan": 1 } } ] }, { "id": "p2.7.121", "order": 213, "type": "table_cell", "bbox": { "l": 468.768, "t": 409.59, "r": 522.984, "b": 392.72 }, "text": "", "attrs": { "row": 12, "col": 8, "rowspan": 1, "colspan": 1 }, "children": [ { "id": "p2.7.121.1", "order": 214, "type": "form_field", "bbox": { "l": 472.92, "t": 408.6, "r": 518.16, "b": 387.72 }, "text": "", "attrs": { "field_kind": "text", "pdf_field_name": "undefined_7", "source": "acroform", "row": 12, "col": 8, "rowspan": 1, "colspan": 1 } } ] }, { "id": "p2.7.122", "order": 215, "type": "table_cell", "bbox": { "l": 522.984, "t": 409.59, "r": 577.2, "b": 392.72 }, "text": "", "attrs": { "row": 12, "col": 9, "rowspan": 1, "colspan": 1 }, "children": [ { "id": "p2.7.122.1", "order": 216, "type": "form_field", "bbox": { "l": 519.72, "t": 408.6, "r": 574.68, "b": 387.72 }, "text": "", "attrs": { "field_kind": "text", "pdf_field_name": "undefined_8", "source": "acroform", "row": 12, "col": 9, "rowspan": 1, "colspan": 1 } } ] }, { "id": "p2.7.123", "order": 217, "type": "table_cell", "bbox": { "l": 42, "t": 407.7001, "r": 128.639, "b": 390.3361 }, "text": "Pneumococcal conjugate (e.g., PCV13) Give PCV13 IM. ^{{3}}", "attrs": { "row": 13, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "children": [ { "id": "p2.7.123.1", "order": 218, "type": "form_field", "bbox": { "l": 133.2, "t": 408.6, "r": 205.8, "b": 387.72 }, "text": "", "attrs": { "field_kind": "text", "label": "e.g., PCV13) Give PCV13 IM.3", "pdf_field_name": "eg PCV13 Give PCV13 IM3", "source": "acroform", "row": 13, "col": 0, "rowspan": 1, "colspan": 1, "label_source": "parent_text", "label_ref": "p2.7.123", "text_offset": 35, "text_span": 0 } } ] }, { "id": "p2.7.124", "order": 219, "type": "table_cell", "bbox": { "l": 89.256, "t": 392.72, "r": 143.472, "b": 375.85 }, "text": "", "attrs": { "row": 13, "col": 1, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.125", "order": 220, "type": "table_cell", "bbox": { "l": 143.472, "t": 392.72, "r": 197.688, "b": 375.85 }, "text": "", "attrs": { "row": 13, "col": 2, "rowspan": 1, "colspan": 1 }, "children": [ { "id": "p2.7.125.1", "order": 221, "type": "form_field", "bbox": { "l": 132.96, "t": 386.52, "r": 206.04, "b": 373.44 }, "text": "", "attrs": { "field_kind": "text", "pdf_field_name": "Pneumococcal polysac", "source": "acroform", "row": 13, "col": 2, "rowspan": 1, "colspan": 1 } } ] }, { "id": "p2.7.126", "order": 222, "type": "table_cell", "bbox": { "l": 197.688, "t": 392.72, "r": 251.904, "b": 375.85 }, "text": "", "attrs": { "row": 13, "col": 3, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.127", "order": 223, "type": "table_cell", "bbox": { "l": 251.904, "t": 392.72, "r": 306.12, "b": 375.85 }, "text": "", "attrs": { "row": 13, "col": 4, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.128", "order": 224, "type": "table_cell", "bbox": { "l": 306.12, "t": 392.72, "r": 360.336, "b": 375.85 }, "text": "", "attrs": { "row": 13, "col": 5, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.129", "order": 225, "type": "table_cell", "bbox": { "l": 360.336, "t": 392.72, "r": 414.552, "b": 375.85 }, "text": "", "attrs": { "row": 13, "col": 6, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.130", "order": 226, "type": "table_cell", "bbox": { "l": 414.552, "t": 392.72, "r": 468.768, "b": 375.85 }, "text": "", "attrs": { "row": 13, "col": 7, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.131", "order": 227, "type": "table_cell", "bbox": { "l": 468.768, "t": 392.72, "r": 522.984, "b": 375.85 }, "text": "", "attrs": { "row": 13, "col": 8, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.132", "order": 228, "type": "table_cell", "bbox": { "l": 522.984, "t": 392.72, "r": 577.2, "b": 375.85 }, "text": "", "attrs": { "row": 13, "col": 9, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.133", "order": 229, "type": "table_cell", "bbox": { "l": 35.04, "t": 375.85, "r": 89.256, "b": 358.98 }, "text": "Pneumococcal polysaccharide (e.g., PPSV23) Give PPSV23 IM or Subcut. ^{{3}}", "attrs": { "row": 14, "col": 0, "rowspan": 1, "colspan": 1 }, "children": [ { "id": "p2.7.133.1", "order": 230, "type": "form_field", "bbox": { "l": 132.96, "t": 372.72, "r": 206.04, "b": 359.16 }, "text": "", "attrs": { "field_kind": "text", "label": "charide (e.g., PPSV23", "pdf_field_name": "charide eg PPSV23", "source": "acroform", "row": 14, "col": 2, "rowspan": 1, "colspan": 1, "label_source": "parent_text", "label_ref": "p2.7.133", "text_offset": 34, "text_span": 0 } } ] }, { "id": "p2.7.134", "order": 231, "type": "table_cell", "bbox": { "l": 89.256, "t": 375.85, "r": 143.472, "b": 358.98 }, "text": "", "attrs": { "row": 14, "col": 1, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.135", "order": 232, "type": "table_cell", "bbox": { "l": 143.472, "t": 375.85, "r": 197.688, "b": 358.98 }, "text": "", "attrs": { "row": 14, "col": 2, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.136", "order": 233, "type": "table_cell", "bbox": { "l": 197.688, "t": 375.85, "r": 251.904, "b": 358.98 }, "text": "", "attrs": { "row": 14, "col": 3, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.137", "order": 234, "type": "table_cell", "bbox": { "l": 251.904, "t": 375.85, "r": 306.12, "b": 358.98 }, "text": "", "attrs": { "row": 14, "col": 4, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.138", "order": 235, "type": "table_cell", "bbox": { "l": 306.12, "t": 375.85, "r": 360.336, "b": 358.98 }, "text": "", "attrs": { "row": 14, "col": 5, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.139", "order": 236, "type": "table_cell", "bbox": { "l": 360.336, "t": 375.85, "r": 414.552, "b": 358.98 }, "text": "", "attrs": { "row": 14, "col": 6, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.140", "order": 237, "type": "table_cell", "bbox": { "l": 414.552, "t": 375.85, "r": 468.768, "b": 358.98 }, "text": "", "attrs": { "row": 14, "col": 7, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.141", "order": 238, "type": "table_cell", "bbox": { "l": 468.768, "t": 375.85, "r": 522.984, "b": 358.98 }, "text": "", "attrs": { "row": 14, "col": 8, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.142", "order": 239, "type": "table_cell", "bbox": { "l": 522.984, "t": 375.85, "r": 577.2, "b": 358.98 }, "text": "", "attrs": { "row": 14, "col": 9, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.143", "order": 240, "type": "table_cell", "bbox": { "l": 42, "t": 342.5, "r": 128.9162, "b": 304.84 }, "text": "Zoster (HZV) Give Subcut. ^{{3}}\nHib Give IM. ^{{3}}\nOther", "attrs": { "row": 15, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "children": [ { "id": "p2.7.143.1", "order": 241, "type": "form_field", "bbox": { "l": 132.96, "t": 343.8, "r": 206.04, "b": 330.72 }, "text": "", "attrs": { "field_kind": "text", "label": "Zoster (HZV) Give Subcut. ^{{3}}\nHib Give IM. ^{{3}}\nOther", "pdf_field_name": "Zoster HZV Give Subcut3", "source": "acroform", "row": 15, "col": 0, "rowspan": 1, "colspan": 1, "label_source": "parent_text", "label_ref": "p2.7.143", "text_offset": 25, "text_span": 0 } }, { "id": "p2.7.143.2", "order": 242, "type": "form_field", "bbox": { "l": 132.96, "t": 329.52, "r": 206.04, "b": 316.44 }, "text": "", "attrs": { "field_kind": "text", "label": "Hib Give IM.3", "pdf_field_name": "Hib Give IM3", "source": "acroform", "row": 15, "col": 0, "rowspan": 1, "colspan": 1, "label_source": "parent_text", "label_ref": "p2.7.143", "text_offset": 45, "text_span": 0 } }, { "id": "p2.7.143.3", "order": 243, "type": "form_field", "bbox": { "l": 132.96, "t": 315.24, "r": 206.04, "b": 302.16 }, "text": "", "attrs": { "field_kind": "text", "pdf_field_name": "Other", "source": "acroform", "label": "HZV", "row": 15, "col": 0, "rowspan": 1, "colspan": 1, "label_source": "parent_text", "label_ref": "p2.7.143", "text_offset": 58, "text_span": 0 } }, { "id": "p2.7.143.4", "order": 244, "type": "form_field", "bbox": { "l": 132.96, "t": 301.44, "r": 206.04, "b": 287.88 }, "text": "", "attrs": { "field_kind": "text", "label": "Other", "pdf_field_name": "Other_2", "source": "acroform", "row": 15, "col": 0, "rowspan": 1, "colspan": 1, "label_source": "parent_text", "label_ref": "p2.7.143", "text_offset": 58, "text_span": 0 } } ] }, { "id": "p2.7.144", "order": 245, "type": "table_cell", "bbox": { "l": 89.256, "t": 358.98, "r": 143.472, "b": 342.11 }, "text": "", "attrs": { "row": 15, "col": 1, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.145", "order": 246, "type": "table_cell", "bbox": { "l": 143.472, "t": 358.98, "r": 197.688, "b": 342.11 }, "text": "", "attrs": { "row": 15, "col": 2, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.146", "order": 247, "type": "table_cell", "bbox": { "l": 197.688, "t": 358.98, "r": 251.904, "b": 342.11 }, "text": "", "attrs": { "row": 15, "col": 3, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.147", "order": 248, "type": "table_cell", "bbox": { "l": 251.904, "t": 358.98, "r": 306.12, "b": 342.11 }, "text": "", "attrs": { "row": 15, "col": 4, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.148", "order": 249, "type": "table_cell", "bbox": { "l": 306.12, "t": 358.98, "r": 360.336, "b": 342.11 }, "text": "", "attrs": { "row": 15, "col": 5, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.149", "order": 250, "type": "table_cell", "bbox": { "l": 360.336, "t": 358.98, "r": 414.552, "b": 342.11 }, "text": "", "attrs": { "row": 15, "col": 6, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.150", "order": 251, "type": "table_cell", "bbox": { "l": 414.552, "t": 358.98, "r": 468.768, "b": 342.11 }, "text": "", "attrs": { "row": 15, "col": 7, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.151", "order": 252, "type": "table_cell", "bbox": { "l": 468.768, "t": 358.98, "r": 522.984, "b": 342.11 }, "text": "", "attrs": { "row": 15, "col": 8, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.152", "order": 253, "type": "table_cell", "bbox": { "l": 522.984, "t": 358.98, "r": 577.2, "b": 342.11 }, "text": "", "attrs": { "row": 15, "col": 9, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.153", "order": 254, "type": "table_cell", "bbox": { "l": 35.04, "t": 308.37, "r": 89.256, "b": 291.5 }, "text": "", "attrs": { "row": 16, "col": 0, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.154", "order": 255, "type": "table_cell", "bbox": { "l": 89.256, "t": 308.37, "r": 143.472, "b": 291.5 }, "text": "", "attrs": { "row": 16, "col": 1, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.155", "order": 256, "type": "table_cell", "bbox": { "l": 143.472, "t": 308.37, "r": 197.688, "b": 291.5 }, "text": "", "attrs": { "row": 16, "col": 2, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.156", "order": 257, "type": "table_cell", "bbox": { "l": 197.688, "t": 308.37, "r": 251.904, "b": 291.5 }, "text": "", "attrs": { "row": 16, "col": 3, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.157", "order": 258, "type": "table_cell", "bbox": { "l": 251.904, "t": 308.37, "r": 306.12, "b": 291.5 }, "text": "", "attrs": { "row": 16, "col": 4, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.158", "order": 259, "type": "table_cell", "bbox": { "l": 306.12, "t": 308.37, "r": 360.336, "b": 291.5 }, "text": "", "attrs": { "row": 16, "col": 5, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.159", "order": 260, "type": "table_cell", "bbox": { "l": 360.336, "t": 308.37, "r": 414.552, "b": 291.5 }, "text": "", "attrs": { "row": 16, "col": 6, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.160", "order": 261, "type": "table_cell", "bbox": { "l": 414.552, "t": 308.37, "r": 468.768, "b": 291.5 }, "text": "", "attrs": { "row": 16, "col": 7, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.161", "order": 262, "type": "table_cell", "bbox": { "l": 468.768, "t": 308.37, "r": 522.984, "b": 291.5 }, "text": "", "attrs": { "row": 16, "col": 8, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.162", "order": 263, "type": "table_cell", "bbox": { "l": 522.984, "t": 308.37, "r": 577.2, "b": 291.5 }, "text": "", "attrs": { "row": 16, "col": 9, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.163", "order": 264, "type": "table_cell", "bbox": { "l": 35.04, "t": 291.5, "r": 89.256, "b": 274.63 }, "text": "", "attrs": { "row": 17, "col": 0, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.164", "order": 265, "type": "table_cell", "bbox": { "l": 89.256, "t": 291.5, "r": 143.472, "b": 274.63 }, "text": "", "attrs": { "row": 17, "col": 1, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.165", "order": 266, "type": "table_cell", "bbox": { "l": 143.472, "t": 291.5, "r": 197.688, "b": 274.63 }, "text": "", "attrs": { "row": 17, "col": 2, "rowspan": 1, "colspan": 1 }, "children": [ { "id": "p2.7.165.1", "order": 267, "type": "form_field", "bbox": { "l": 132.96, "t": 287.16, "r": 206.04, "b": 273.72 }, "text": "", "attrs": { "field_kind": "text", "label": "Other", "pdf_field_name": "Other_3", "source": "acroform", "row": 17, "col": 2, "rowspan": 1, "colspan": 1 } } ] }, { "id": "p2.7.166", "order": 268, "type": "table_cell", "bbox": { "l": 197.688, "t": 291.5, "r": 251.904, "b": 274.63 }, "text": "", "attrs": { "row": 17, "col": 3, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.167", "order": 269, "type": "table_cell", "bbox": { "l": 251.904, "t": 291.5, "r": 306.12, "b": 274.63 }, "text": "", "attrs": { "row": 17, "col": 4, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.168", "order": 270, "type": "table_cell", "bbox": { "l": 306.12, "t": 291.5, "r": 360.336, "b": 274.63 }, "text": "", "attrs": { "row": 17, "col": 5, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.169", "order": 271, "type": "table_cell", "bbox": { "l": 360.336, "t": 291.5, "r": 414.552, "b": 274.63 }, "text": "", "attrs": { "row": 17, "col": 6, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.170", "order": 272, "type": "table_cell", "bbox": { "l": 414.552, "t": 291.5, "r": 468.768, "b": 274.63 }, "text": "", "attrs": { "row": 17, "col": 7, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.171", "order": 273, "type": "table_cell", "bbox": { "l": 468.768, "t": 291.5, "r": 522.984, "b": 274.63 }, "text": "", "attrs": { "row": 17, "col": 8, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.172", "order": 274, "type": "table_cell", "bbox": { "l": 522.984, "t": 291.5, "r": 577.2, "b": 274.63 }, "text": "", "attrs": { "row": 17, "col": 9, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.173", "order": 275, "type": "table_cell", "bbox": { "l": 35.04, "t": 274.63, "r": 89.256, "b": 257.76 }, "text": "", "attrs": { "row": 18, "col": 0, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.174", "order": 276, "type": "table_cell", "bbox": { "l": 89.256, "t": 274.63, "r": 143.472, "b": 257.76 }, "text": "", "attrs": { "row": 18, "col": 1, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.175", "order": 277, "type": "table_cell", "bbox": { "l": 143.472, "t": 274.63, "r": 197.688, "b": 257.76 }, "text": "", "attrs": { "row": 18, "col": 2, "rowspan": 1, "colspan": 1 }, "children": [ { "id": "p2.7.175.1", "order": 278, "type": "form_field", "bbox": { "l": 132.96, "t": 273, "r": 206.04, "b": 259.68 }, "text": "", "attrs": { "field_kind": "text", "label": "Other", "pdf_field_name": "Other_4", "source": "acroform", "row": 18, "col": 2, "rowspan": 1, "colspan": 1 } } ] }, { "id": "p2.7.176", "order": 279, "type": "table_cell", "bbox": { "l": 197.688, "t": 274.63, "r": 251.904, "b": 257.76 }, "text": "", "attrs": { "row": 18, "col": 3, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.177", "order": 280, "type": "table_cell", "bbox": { "l": 251.904, "t": 274.63, "r": 306.12, "b": 257.76 }, "text": "", "attrs": { "row": 18, "col": 4, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.178", "order": 281, "type": "table_cell", "bbox": { "l": 306.12, "t": 274.63, "r": 360.336, "b": 257.76 }, "text": "", "attrs": { "row": 18, "col": 5, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.179", "order": 282, "type": "table_cell", "bbox": { "l": 360.336, "t": 274.63, "r": 414.552, "b": 257.76 }, "text": "", "attrs": { "row": 18, "col": 6, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.180", "order": 283, "type": "table_cell", "bbox": { "l": 414.552, "t": 274.63, "r": 468.768, "b": 257.76 }, "text": "", "attrs": { "row": 18, "col": 7, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.181", "order": 284, "type": "table_cell", "bbox": { "l": 468.768, "t": 274.63, "r": 522.984, "b": 257.76 }, "text": "", "attrs": { "row": 18, "col": 8, "rowspan": 1, "colspan": 1 } }, { "id": "p2.7.182", "order": 285, "type": "table_cell", "bbox": { "l": 522.984, "t": 274.63, "r": 577.2, "b": 257.76 }, "text": "", "attrs": { "row": 18, "col": 9, "rowspan": 1, "colspan": 1 } } ] }, { "id": "p2.8", "order": 286, "type": "list_item", "bbox": { "l": 33.84, "t": 255.19010000000003, "r": 312, "b": 228.72 }, "text": "See page 1 to record Tdap/Td, hepatitis A, hepatitis B, HPV, MMR, varicella, MenACWY, and MenB vaccines." }, { "id": "p2.9", "order": 287, "type": "heading", "bbox": { "l": 34.08, "t": 218.16, "r": 172.32, "b": 206.16 }, "text": "How to Complete this Record", "attrs": { "block_label": "paragraph_title" }, "level": 3 }, { "id": "p2.10", "order": 288, "type": "list", "bbox": { "l": 33.84, "t": 203.52, "r": 320.16, "b": 66.24 }, "text": "", "attrs": { "item_count": 5 }, "children": [ { "id": "p2.10.1", "order": 289, "type": "list_item", "bbox": { "l": 35.04, "t": 203.52, "r": 310.08, "b": 182.88 }, "text": "Record the generic abbreviation (e.g., Tdap) or the trade name for each vaccine (see table at right).", "marker": "1." }, { "id": "p2.10.2", "order": 290, "type": "list_item", "bbox": { "l": 34.32, "t": 182.4, "r": 297.84, "b": 161.04 }, "text": "Record the funding source of the vaccine given as either F (federal), S (state), or P (private).", "marker": "2." }, { "id": "p2.10.3", "order": 291, "type": "list_item", "bbox": { "l": 34.08, "t": 161.04, "r": 320.16, "b": 119.52 }, "text": "Record the route by which the vaccine was given as either intramuscular (IM), subcutaneous (Subcut), intradermal (ID), intranasal (NAS), or oral (PO) and also the site where it was administered as either RA (right arm), LA (left arm), RT (right thigh), or LT (left thigh).", "marker": "3." }, { "id": "p2.10.4", "order": 292, "type": "list_item", "bbox": { "l": 34.08, "t": 119.28, "r": 301.92, "b": 98.16 }, "text": "Record the publication date of each VIS as well as the date the VIS is given to the patient.", "marker": "4." }, { "id": "p2.10.5", "order": 293, "type": "list_item", "bbox": { "l": 33.84, "t": 97.92, "r": 316.08, "b": 66.24 }, "text": "To meet the space constraints of this form and federal requirements for documentation, a healthcare setting may want to keep a reference list of vaccinators that includes their initials and titles.", "marker": "5." } ] }, { "id": "p2.11", "order": 294, "type": "table", "bbox": { "l": 340.56, "t": 231.12, "r": 576.24, "b": 69.12 }, "text": "", "attrs": { "block_label": "table", "n_rows": 4, "n_cols": 2, "integrity": { "cells_checked": 8, "cells_flagged": 0 } }, "children": [ { "id": "p2.11.1", "order": 295, "type": "table_cell", "bbox": { "l": 345.95, "t": 228.6775, "r": 385.25, "b": 220.0525 }, "text": "Abbreviation", "attrs": { "row": 0, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true, "column_header": true, "header_source": "pdf" }, "children": [ { "id": "p2.11.1.1", "order": 296, "type": "form_field", "bbox": { "l": 384.6, "t": 230.28, "r": 420.72, "b": 217.68 }, "text": "", "attrs": { "field_kind": "text", "pdf_field_name": "Abbreviation", "source": "acroform", "row": 0, "col": 0, "rowspan": 1, "colspan": 1, "label": "Abbreviation", "label_source": "parent_text", "label_ref": "p2.11.1", "text_offset": 12, "text_span": 0 } } ] }, { "id": "p2.11.2", "order": 297, "type": "table_cell", "bbox": { "l": 426.2, "t": 228.6775, "r": 521.945, "b": 220.0525 }, "text": "Trade Name and Manufacturer", "attrs": { "row": 0, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true, "column_header": true, "header_source": "pdf" }, "children": [ { "id": "p2.11.2.1", "order": 298, "type": "form_field", "bbox": { "l": 521.4, "t": 230.28, "r": 575.4, "b": 217.68 }, "text": "", "attrs": { "field_kind": "text", "label": "Trade Name and Manufacturer", "pdf_field_name": "Trade Name and Manufacturer_2", "source": "acroform", "row": 0, "col": 1, "rowspan": 1, "colspan": 1, "label_source": "parent_text", "label_ref": "p2.11.2", "text_offset": 27, "text_span": 0 } } ] }, { "id": "p2.11.3", "order": 299, "type": "table_cell", "bbox": { "l": 345.95, "t": 215.23199999999997, "r": 417.03101, "b": 147.96500000000003 }, "text": "IIV3 (inactivated influenza vaccine, trivalent); IIV4 (inactivated influenza vaccine, quadrivalent); ccIIV3 (cell culture-based inactivated influenza vaccine, trivalent); RIV3 (inactivated recombinant influenza vaccine, trivalent)", "attrs": { "row": 1, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "children": [ { "id": "p2.11.3.1", "order": 300, "type": "form_field", "bbox": { "l": 424.496, "t": 168.092, "r": 574.496, "b": 146.092 }, "text": "", "attrs": { "field_kind": "text", "label": "(inactivated recombinant", "pdf_field_name": "Text7", "source": "acroform", "row": 1, "col": 0, "rowspan": 1, "colspan": 1, "label_source": "parent_text", "label_ref": "p2.11.3", "text_offset": 200, "text_span": 0 } } ] }, { "id": "p2.11.4", "order": 301, "type": "table_cell", "bbox": { "l": 426.2, "t": 199.48199999999997, "r": 565.638, "b": 169.71500000000003 }, "text": "Fluarix (GSK); Flublok (Protein Sciences Corp.); Afluria, Fluad, Flucelvax, Fluvirin (Seqirus); FluLaval (GSK); Fluzone, Fluzone Intradermal, Fluzone High-Dose (Sanofi Pasteur)", "attrs": { "row": 1, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p2.11.5", "order": 302, "type": "table_cell", "bbox": { "l": 345.95, "t": 142.66110000000003, "r": 402.37, "b": 127.89409999999998 }, "text": "LAIV (live attenuated influenza vaccine, quadrivalent)", "attrs": { "row": 2, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "children": [ { "id": "p2.11.5.1", "order": 303, "type": "form_field", "bbox": { "l": 371.294, "t": 127.912, "r": 420.844, "b": 117.817 }, "text": "", "attrs": { "field_kind": "text", "label": "rivalent]", "pdf_field_name": "Text6", "source": "acroform", "row": 2, "col": 0, "rowspan": 1, "colspan": 1, "label_source": "parent_text", "label_ref": "p2.11.5", "text_offset": 31, "text_span": 0 } } ] }, { "id": "p2.11.6", "order": 304, "type": "table_cell", "bbox": { "l": 426.2, "t": 134.7111, "r": 488.561, "b": 127.44410000000005 }, "text": "FluMist (MedImmune)", "attrs": { "row": 2, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "children": [ { "id": "p2.11.6.1", "order": 305, "type": "form_field", "bbox": { "l": 488.4, "t": 143.76, "r": 574.92, "b": 117.48 }, "text": "", "attrs": { "field_kind": "text", "label": "FluMist (MedImmune)", "pdf_field_name": "FluMist MedImmune", "source": "acroform", "row": 2, "col": 1, "rowspan": 1, "colspan": 1, "label_source": "parent_text", "label_ref": "p2.11.6", "text_offset": 19, "text_span": 0 } }, { "id": "p2.11.6.2", "order": 306, "type": "form_field", "bbox": { "l": 366.24, "t": 107.4, "r": 420.84, "b": 98.76 }, "text": "", "attrs": { "field_kind": "text", "pdf_field_name": "PPSV23", "source": "acroform", "label": "MedImmune", "row": 2, "col": 1, "rowspan": 1, "colspan": 1, "label_source": "parent_text", "label_ref": "p2.11.6" } } ] }, { "id": "p2.11.7", "order": 307, "type": "table_cell", "bbox": { "l": 345.95, "t": 116.24559999999997, "r": 387.303, "b": 75.54309999999998 }, "text": "PCV13\nPPSV23\nHZV (shingles)\nHib", "attrs": { "row": 3, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "children": [ { "id": "p2.11.7.1", "order": 308, "type": "form_field", "bbox": { "l": 386.64, "t": 98.04, "r": 420.84, "b": 89.4 }, "text": "", "attrs": { "field_kind": "text", "label": "HZV (shingles)", "pdf_field_name": "HZV shingles", "source": "acroform", "row": 3, "col": 0, "rowspan": 1, "colspan": 1, "label_source": "parent_text", "label_ref": "p2.11.7", "text_offset": 27, "text_span": 0 } }, { "id": "p2.11.7.2", "order": 309, "type": "form_field", "bbox": { "l": 355.68, "t": 88.32, "r": 420.48, "b": 69.36 }, "text": "", "attrs": { "field_kind": "text", "pdf_field_name": "Hib", "source": "acroform", "label": "shingles", "row": 3, "col": 0, "rowspan": 1, "colspan": 1, "label_source": "parent_text", "label_ref": "p2.11.7", "text_offset": 31, "text_span": 0 } } ] }, { "id": "p2.11.8", "order": 310, "type": "table_cell", "bbox": { "l": 426.2, "t": 116.24559999999997, "r": 563.831, "b": 72.24310000000003 }, "text": "Prevnar 13 (Pfizer)\nPneumovax 23 (Merck)\nZostavax (Merck)\nActHIB (Sanofi Pasteur); Hiberix (GSK); PedvaxHib (Merck)", "attrs": { "row": 3, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "children": [ { "id": "p2.11.8.1", "order": 311, "type": "form_field", "bbox": { "l": 362.76, "t": 116.76, "r": 420.84, "b": 108.12 }, "text": "", "attrs": { "field_kind": "text", "pdf_field_name": "PCV13", "source": "acroform", "label": "shingles", "row": 3, "col": 1, "rowspan": 1, "colspan": 1, "label_source": "adjacent_text", "label_ref": "p2.11.7" } }, { "id": "p2.11.8.2", "order": 312, "type": "form_field", "bbox": { "l": 475.44, "t": 116.76, "r": 575.52, "b": 108.12 }, "text": "", "attrs": { "field_kind": "text", "label": "MedImmune", "pdf_field_name": "Prevnar 13 Pfizer", "source": "acroform", "row": 3, "col": 1, "rowspan": 1, "colspan": 1, "label_source": "adjacent_text", "label_ref": "p2.11.6", "text_offset": 19, "text_span": 0 } }, { "id": "p2.11.8.3", "order": 313, "type": "form_field", "bbox": { "l": 488.04, "t": 107.4, "r": 575.52, "b": 98.76 }, "text": "", "attrs": { "field_kind": "text", "label": "Pneumovax 23 (Merck)", "pdf_field_name": "Pneumovax 23 Merck", "source": "acroform", "row": 3, "col": 1, "rowspan": 1, "colspan": 1, "label_source": "parent_text", "label_ref": "p2.11.8", "text_offset": 40, "text_span": 0 } }, { "id": "p2.11.8.4", "order": 314, "type": "form_field", "bbox": { "l": 472.56, "t": 98.04, "r": 575.52, "b": 89.4 }, "text": "", "attrs": { "field_kind": "text", "label": "Zostavax (Merck)", "pdf_field_name": "Zostavax Merck", "source": "acroform", "row": 3, "col": 1, "rowspan": 1, "colspan": 1, "label_source": "parent_text", "label_ref": "p2.11.8", "text_offset": 57, "text_span": 0 } }, { "id": "p2.11.8.5", "order": 315, "type": "form_field", "bbox": { "l": 450.166, "t": 79.5471, "r": 571.891, "b": 69.8243 }, "text": "", "attrs": { "field_kind": "text", "label": "Merck", "pdf_field_name": "Text8", "source": "acroform", "row": 3, "col": 1, "rowspan": 1, "colspan": 1, "label_source": "parent_text", "label_ref": "p2.11.8", "text_offset": 115, "text_span": 0 } } ] } ] }, { "id": "p2.12", "order": 316, "type": "footer", "bbox": { "l": 35.28, "t": 48.96, "r": 508.8, "b": 37.68 }, "text": "Immunization Action Coalition · Saint Paul, Minnesota · 651-647-9009 · www.immunize.org · www.vaccineinformation.org", "attrs": { "block_label": "footer" } }, { "id": "p2.13", "order": 317, "type": "footer", "bbox": { "l": 348.96, "t": 35.28, "r": 576.96, "b": 25.44 }, "text": "www.immunize.org/catg.d/p2023.pdf Item #P2023-page 2 (4/16)", "attrs": { "block_label": "footer" } } ], "excluded_furniture": { "first": [], "last": [] } }