Get the free DSHS C-85 Pneumococcal Conjugate VIS addendum ... - Winona ISD
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Texas Department of State Health Services
Addendum to Pneumococcal Conjugate
Vaccine Information Statement
1. I agree that the person named below will get the vaccine checked below.
2. I received
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How to fill out dshs c-85 pneumococcal conjugate
Who needs dshs c-85 pneumococcal conjugate?
01
Dshs c-85 pneumococcal conjugate is typically recommended for infants and young children to protect them against pneumococcal diseases, such as pneumonia, meningitis, and ear infections.
02
It is also recommended for adults who are at higher risk of contracting pneumococcal infections, such as those with weakened immune systems, chronic illnesses, or certain medical conditions.
03
Consult with a healthcare professional to determine whether you or your child falls into the recommended group that needs dshs c-85 pneumococcal conjugate vaccination.
How to fill out dshs c-85 pneumococcal conjugate?
01
Obtain the dshs c-85 pneumococcal conjugate form from your healthcare provider or local health department.
02
Carefully read the instructions provided on the form to ensure accurate completion.
03
Fill in all the required personal information, such as the name, date of birth, address, and contact details of the individual receiving the vaccination.
04
Provide information about the healthcare provider administering the vaccine, including their name, credentials, and contact information.
05
Indicate the vaccine brand and lot number on the form, which should be provided by the healthcare provider.
06
Specify the date on which the pneumococcal conjugate vaccination was administered.
07
Sign and date the form to authenticate the information provided.
08
Keep a copy of the completed form for personal records and submit the original to the relevant authority, such as your healthcare provider or local health department, as instructed.
Note: Always follow the instructions provided by your healthcare provider or local health department when filling out any medical forms.
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What is dshs c-85 pneumococcal conjugate?
The dshs c-85 pneumococcal conjugate is a report form used to document the administration of the pneumococcal conjugate vaccine.
Who is required to file dshs c-85 pneumococcal conjugate?
Healthcare providers and facilities that administer the pneumococcal conjugate vaccine are required to file the dshs c-85 form.
How to fill out dshs c-85 pneumococcal conjugate?
The dshs c-85 form should be completed with the patient's information, vaccine details, and provider's signature. It must be filled out accurately and completely.
What is the purpose of dshs c-85 pneumococcal conjugate?
The purpose of the dshs c-85 form is to track and report the administration of the pneumococcal conjugate vaccine to ensure proper immunization coverage.
What information must be reported on dshs c-85 pneumococcal conjugate?
The dshs c-85 form requires information such as patient demographics, vaccine lot number, administration date, and provider's information.
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