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This document provides information regarding meningococcal disease, the associated risks, vaccination options, and compliance with New York State Public Health Law regarding vaccination requirements
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How to fill out meningococcal vaccine information and

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How to fill out Meningococcal Vaccine Information and Acknowledgment

01
Obtain the Meningococcal Vaccine Information and Acknowledgment form from your healthcare provider or institution.
02
Read the information provided in the document carefully, as it contains important details about the vaccine.
03
Fill in your personal information at the top of the form, including your name, date of birth, and contact information.
04
Indicate the date of the vaccination, if applicable, or the date you plan to receive it.
05
Acknowledge your understanding of the vaccine's benefits and risks by signing the form.
06
If you have any questions or concerns, discuss them with your healthcare provider before signing.
07
Submit the completed form to the appropriate office or keep it for your records, as instructed.

Who needs Meningococcal Vaccine Information and Acknowledgment?

01
Individuals who are recommended to receive the Meningococcal vaccine, especially adolescents and young adults, including college students living in dormitories.
02
People who are traveling to areas where Meningococcal disease is prevalent.
03
Those with specific medical conditions or compromised immune systems that may increase their risk for Meningococcal disease.
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What happens if you don't have meningococcal vaccine? You could get meningococcal disease, which is a very serious, life-threatening condition. SOURCES: National Meningitis Association: "About Meningococcal Disease."
Administer 2 or 3 doses. Administer 2 doses to healthy adolescents who are not at increased risk for serogroup B meningococcal disease. Administer the second dose 6 months after the first dose. Administer 3 doses to people 10 years of age or older who are at increased risk for meningococcal disease.
Meningococcal disease is a very serious infection that can cause severe scarring, loss of limbs, brain damage and death. Vaccination is a safe and effective way to protect yourself from meningococcal disease. Meningococcal disease is most commonly caused by types A, B, C, W and Y.
MenACWY vaccines Since protection decreases over time, CDC recommends a booster shot at 16 years old. The booster shot provides protection during the ages when teens are at highest risk of meningococcal disease. Many colleges require proof of MenACWY vaccination within 5 years before starting school.
How and when should you receive the meningococcal vaccine? In most cases, adults only need one dose. But if you remain at risk, you may need a booster.
Key points. CDC recommends meningococcal vaccination for all adolescents. CDC also recommends meningococcal vaccination for children and adults at increased risk for meningococcal disease. Follow the recommended immunization schedule to ensure that your patients get the meningococcal vaccines that they need.
CDC recommends meningococcal vaccination for all preteens and teens, as well as other children and adults at increased risk. Meningococcal vaccines are the best way to protect against meningococcal disease, but side effects can occur. Talk to a vaccine provider if you have questions about meningococcal vaccines.
Administer 2 or 3 doses. Administer 2 doses to healthy adolescents who are not at increased risk for serogroup B meningococcal disease. Administer the second dose 6 months after the first dose. Administer 3 doses to people 10 years of age or older who are at increased risk for meningococcal disease.
Depending on the age at which immunization is initiated, the manufacturer of 4CMenB recommends two or three primary doses and a booster (2 + 1 schedule or 3 + 1 schedule) when the first dose is received between the ages of 2 and 5 months, and two primary doses and a booster (2 + 1 schedule) when the first dose is
Meningococcal vaccine is a shot to help prevent meningococcal disease. The disease is most common in babies, teens, and young adults. It's also more common in people who have a very weak immune system, are sexually active with multiple partners (especially men who have sex with men), or are over age 65.

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Meningococcal Vaccine Information and Acknowledgment is a document that provides information about the meningococcal vaccine, its benefits, risks, and recommendations for vaccination. It requires acknowledgment from the recipient or their guardian regarding the understanding of this information.
Typically, healthcare providers administering the meningococcal vaccine are required to file the Meningococcal Vaccine Information and Acknowledgment to ensure that patients or their guardians are informed about the vaccine and its implications.
To fill out the Meningococcal Vaccine Information and Acknowledgment, individuals need to provide personal information of the vaccine recipient, confirm understanding of the information regarding the vaccine, and sign the acknowledgment section of the form.
The purpose of the Meningococcal Vaccine Information and Acknowledgment is to ensure that vaccine recipients and their guardians are fully informed about the meningococcal vaccine, including its benefits and potential side effects, prior to vaccination.
The information that must be reported includes the recipient's name, date of birth, the date of the vaccine administration, the name of the vaccine, and the signature of the recipient or guardian indicating acknowledgment of the information provided.
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