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INFLUENZA VACCINE 20152016 CONSENT FORM Name: (print) Date of Birth: SS#: Street Address: City: State: Zip Code: Phone Number: Vaccine Information Sheet edition date Inactivated Influenza Vaccine

How to fill out influenza vaccine 2015-2016 consent

How to fill out influenza vaccine 2015-2016 consent:

1. Read the consent form carefully: Start by thoroughly reading the influenza vaccine 2015-2016 consent form to understand the information and instructions provided.
2. Provide personal information: Fill in your personal details such as your full name, date of birth, address, and contact information.
3. Verify the vaccine date and location: Check the consent form for the specific date and location of the influenza vaccine administration. Ensure that the details match your intended vaccination appointment.
4. Review medical history: Carefully go through the medical history section of the consent form. Provide accurate information about any existing medical conditions, allergies, and previous adverse reactions to vaccines.
5. Discuss medication and pregnancy status: Inform healthcare professionals if you are taking any medications or if you are pregnant or planning to become pregnant. These factors may be important for determining the suitability of the influenza vaccine.
6. Signature and date: Sign and date the consent form to indicate your agreement and understanding of the vaccination process. Make sure to sign with your legal signature as it appears on official documents.
7. Ask questions: If you have any doubts or concerns about the consent form or the influenza vaccine, don't hesitate to ask healthcare professionals for clarification. They will be able to address any queries you may have.

Who needs influenza vaccine 2015-2016 consent?

1. Individuals receiving the influenza vaccine: Anyone who is planning to receive the influenza vaccine during the 2015-2016 period may require consent. This includes children, adults, and individuals belonging to high-risk groups such as pregnant women, elderly individuals, and individuals with chronic medical conditions.
2. Minors: In the case of minors, a parent or legal guardian will usually be required to provide consent on their behalf.
3. Specific institutional requirements: Depending on the policies of certain organizations or institutions, individuals may be asked to provide consent for administrative purposes or documentation.

It's important to note that the specific requirements for influenza vaccine consent may vary based on local regulations and healthcare provider preferences. Therefore, it is always advisable to consult with healthcare professionals or the concerned institution for accurate and up-to-date information.

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What is influenza vaccine consent form?

The influenza vaccine consent form is a document that gives permission for an individual to receive the influenza vaccine.

Who is required to file influenza vaccine consent form?

The influenza vaccine consent form is required to be filed by individuals who wish to receive the influenza vaccine.

How to fill out influenza vaccine consent form?

To fill out the influenza vaccine consent form, one must provide their personal information, medical history, and signature to authorize the receipt of the vaccine.

What is the purpose of influenza vaccine consent form?

The purpose of the influenza vaccine consent form is to ensure that individuals understand the risks and benefits of receiving the influenza vaccine and give explicit permission to receive it.

What information must be reported on influenza vaccine consent form?

The influenza vaccine consent form must include personal information, medical history, any allergies, and a signature to authorize the receipt of the vaccine.