Protocol sheet to be included in the patient’s case notes
| Name |
| Age |
| Sex |
| Hospital identification number |
| Splenectomy performed on (date) |
| Indication |
| Pneumococcal vaccination given (yes/no) |
| If vaccinated, vaccination given on (date) |
| Type of vaccine |
| Next booster due on (date) |
| Any other vaccination (meningococcal/influenza) |
| Date |
| Antibiotic prophylaxis (received/not received) |