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.

Last 4 digits of ssn date of birth. If you have answered yes to any of the above questions, consult a physician prior to receiving the flu vaccine. A severe reaction to the flu shot in the past.

Influenza (flu) vaccine (inactivated or recombinant). If no, please proceed to step 2. Influenza (flu) vaccine (inactivated or recombinant):

Qr code links to vaccine information statement (vis) translations: Form your patients fill out to help you evaluate if live. The 2024/2025 trivalent vaccine (tiv) protects against 3 different flu viruses:

Flu vaccine form pdf Fill out & sign online DocHub