Flu Vaccine Consent Form 2024-2025

Flu Vaccine Consent Form 2024-2025 – I consent to receiving the seasonal influenza vaccine. Imm.f.hcp flu consent form revised sept 2024. I understand the benefits and risks of the. Patient name phone # date of birth date.

Two influenza a viruses (h1n1 and h3n2) and one influenza b virus. I am aware that some people experience pain at the site of injection, and some may even experience fever. Physician's name insurance(s) please answer the following questions: I have been provided a copy of and have read or have had explained to me the information about influenza and influenza vaccine.

Flu Vaccine Consent Form 2024-2025

Discussed possible side effects : You must remain in the clinic area 15 minutes after the vaccination is given. Information about influenza vaccine products available in the u.s.

I testify that i have none of the conditions listed below: Influenza (flu) vaccine (inactivated or recombinant). Form your patients fill out to help you evaluate if live.

If no, please proceed to step 2. Qr code links to vaccine information statement (vis) translations: A severe reaction to the flu shot in the past.

Influenza (flu) vaccine (inactivated or recombinant): Yes no if yes, please ask for an employee health consent form. Last name first name m id le inta building / work location.

Flu vaccine administration record template Fill out & sign online DocHub