Get the free Injectable Influenza Vaccine (Flu Shot) Consent and Screening Form

This form is used to obtain consent from parents or guardians for children to receive the influenza vaccine at school, including a screening questionnaire to assess eligibility for vaccination.

How to fill out injectable influenza vaccine flu

How to fill out Injectable Influenza Vaccine (Flu Shot) Consent and Screening Form

1. Begin by reading the instructions on the consent and screening form carefully.
2. Provide your personal information such as name, date of birth, and contact details in the designated sections.
3. Indicate whether you have any allergies, particularly to eggs or other vaccine components.
4. Answer questions related to your medical history, including any current illnesses or conditions.
5. Check relevant boxes to confirm your understanding of the vaccine’s benefits and potential side effects.
6. Sign and date the form to indicate your consent and understanding.

Who needs Injectable Influenza Vaccine (Flu Shot) Consent and Screening Form?

1. Individuals who are receiving the flu shot for the first time.
2. Patients with a medical history that requires assessment before vaccination.
3. Anyone under 18 years old, as a parent or guardian must provide consent.
4. Individuals who are receiving health services where a flu vaccine is administered.

People Also Ask about

What is required documentation when giving a vaccine?

By law, the following information must be documented on the patient's paper or electronic medical record (or on a permanent office log): The vaccine manufacturer. The lot number of the vaccine. The date the vaccine is administered.

What is a flu vaccine administration consent form?

A flu vaccine consent form is a document that is signed by a person who is receiving a flu vaccine. It outlines the risks and benefits of the vaccine, the potential side effects, and the person's permission for the vaccine to be administered.

How do you document the administration of the flu vaccine?

Job Aid Date of administration. Vaccine manufacturer. Vaccine lot number. Name and title of the person who administered the vaccine and address of the facility where the permanent record will reside. Vaccine information statement (VIS) Date printed on the VIS. Date the VIS was given to the patient or parent/guardian.

Are there vaccine consent forms?

Vaccination consent forms There is no Federal requirement for informed consent relating to immunization.

Are there vaccine consent forms?

Vaccination consent forms There is no Federal requirement for informed consent relating to immunization.

How can the flu vaccine be administered?

For adults 19 years of age and older, the deltoid muscle in the upper arm is the preferred site, although the vastus lateralis muscle in the anterolateral thigh may be used if the deltoid site cannot be used. Influenza vaccines are not highly viscous, so a fine-gauge (22- to 25-gauge) needle can be used.

What is informed consent for vaccines?

Consent to Immunization There are no Federal or California State requirements for informed consent specifically relating to immunization. Federal law requires that healthcare staff provide a Vaccine information Statement to a patient, parent, or legal representative before each dose of certain vaccines.

Can your employer require you to get a flu shot?

It is important to note that employees need to be properly informed of the benefits of the vaccinations. However, although OSHA does not specifically require employees to take the vaccines, an employer may do so.

For pdfFiller’s FAQs

What is Injectable Influenza Vaccine (Flu Shot) Consent and Screening Form?

The Injectable Influenza Vaccine (Flu Shot) Consent and Screening Form is a document used to obtain consent from individuals before administering the flu vaccine. It includes a screening process to ensure the recipient is eligible for the vaccination.

Who is required to file Injectable Influenza Vaccine (Flu Shot) Consent and Screening Form?

Individuals who are receiving the flu shot need to have this form completed by the healthcare provider administering the vaccine, as well as consented by the recipient or their guardian.

How to fill out Injectable Influenza Vaccine (Flu Shot) Consent and Screening Form?

The form should be filled out by providing personal details such as name, age, medical history, and any allergies. The recipient or their guardian must sign to give consent before the vaccine is administered.

What is the purpose of Injectable Influenza Vaccine (Flu Shot) Consent and Screening Form?

The purpose of the form is to ensure that individuals are informed about the vaccine, evaluate their medical suitability for vaccination, and secure their consent for the procedure.

What information must be reported on Injectable Influenza Vaccine (Flu Shot) Consent and Screening Form?

The form must include the recipient's personal information, details about their medical history, any allergies, and the date of the vaccination, along with the signature of the individual or guardian providing consent.