UT Influenza Vaccine Consent Form and free printable template

INFLUENZA VACCINE CONSENT FORM AND ADMINISTRATION RECORD Personal Information (PLEASE PRINT) NAME: BIRTHDATE: AGE: ADDRESS: SEX: M F CITY: STATE: ZIP: I have read or have had explained to me the Vaccine

How to fill out flu vaccine consent form pdf

How to fill out UT Influenza Vaccine Consent Form and Administration

1. Download the UT Influenza Vaccine Consent Form from the official website or obtain a physical copy.
2. Fill in your personal information, including your name, date of birth, and contact information at the top of the form.
3. Review the vaccine information section that explains the benefits and potential side effects of the influenza vaccine.
4. Indicate your consent by signing the designated area on the form, confirming that you have read and understood the information provided.
5. Provide any relevant medical history, including allergies or prior reactions to vaccines, in the specified section.
6. Submit the completed form to the designated administration authority at your institution or healthcare provider.

Who needs UT Influenza Vaccine Consent Form and Administration?

1. Students, faculty, and staff at the University of Texas who wish to receive the influenza vaccine.
2. Individuals who are in close proximity to others, especially in communal living or learning environments, to protect themselves and others from influenza.

People Also Ask about flu shot paperwork

What is the difference between the regular flu shot and the senior flu shot?

One flu vaccine recommended for older adults has the same amount of antigen as the standard dose vaccine. But it boosts the immune response by including an ingredient called an adjuvant.

Are there 2 types of flu vaccine this year?

Trivalent Inactivated Influenza Vaccines (IIV3) These flu vaccines provide protection against three strains of influenza (as opposed to four with a quadrivalent vaccine). There are no trivalent vaccines for the 2021-2022 flu season.

How do you give a flu shot?

1 Use a needle long enough to reach deep into the muscle. Infants age 6 through 11 mos: 1"; 1 through 10 yrs: 1–1¼"; and children and adults 11 years and older: 1–1½". 2 With your non-dominant hand, bunch up the muscle. 3 With your dominant hand, insert the needle at a 90° angle to the skin with a quick thrust.

How many doses of influenza vaccine are required?

Kids younger than 9 who got at least 2 doses of flu vaccine before July 2022 will only need 1 dose. Kids older than 9 need only 1 dose of the vaccine.

Is the flu vaccine for type A or B?

A quadrivalent influenza (flu) vaccine is designed to protect against four different flu viruses, including two influenza A viruses and two influenza B viruses. Learn more about the vaccine composition for the current flu season vaccines.

What are the two types of flu shots this year?

Available flu vaccines include: Standard-dose flu shots that are manufactured using virus grown in eggs. A cell-based flu shot (Flucelvax Quadrivalent) containing virus grown in cell culture, which is approved for people 6 months and older.

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What is UT Influenza Vaccine Consent Form and Administration?

The UT Influenza Vaccine Consent Form and Administration is a document that grants permission for the administration of the influenza vaccine to individuals at the University of Texas. It includes details about the vaccine, its benefits, risks, and provides a legal consent for its administration.

Who is required to file UT Influenza Vaccine Consent Form and Administration?

Individuals seeking to receive the influenza vaccine at the University of Texas are required to file the UT Influenza Vaccine Consent Form. This typically includes students, faculty, and staff who are eligible for the vaccination program.

How to fill out UT Influenza Vaccine Consent Form and Administration?

To fill out the UT Influenza Vaccine Consent Form, individuals must provide personal information such as their name, contact details, and any relevant medical history. They must also read the information provided about the vaccine and sign the form to indicate their consent for vaccination.

What is the purpose of UT Influenza Vaccine Consent Form and Administration?

The purpose of the UT Influenza Vaccine Consent Form and Administration is to ensure that individuals are informed about the influenza vaccine, to collect necessary consent for vaccination, and to comply with legal and health regulations related to vaccination procedures.

What information must be reported on UT Influenza Vaccine Consent Form and Administration?

The UT Influenza Vaccine Consent Form must report personal information such as the individual's name, date of birth, contact information, medical history related to allergies or previous vaccine reactions, and a signature indicating consent for receiving the vaccine.