Canada Seasonal Influenza and Pneumococcal Immunization Consent Form - Manitoba 2010 free printable template

Seasonal Influenza and Pneumococcal Vaccine Consent Form Region Clinic Location SECTIONS A B C AND D COMPLETED BY I Client I Parent I Legal decision maker I Other on behalf of client A. Client Information - please print Surname Address Home Phone Given Names City/Town Date of Birth yyyy/mm/dd / / Manitoba Health Number 6 digits Date Postal Code Gender Male I / Female I Personal Health Information Number 9 digits B. Health History of Client 1. Are you well today I Yes I No 2. Do you have any...

How to fill out pneumonia vaccine consent form

How to fill out Canada Seasonal Influenza and Pneumococcal Immunization Consent

1. Obtain the Canada Seasonal Influenza and Pneumococcal Immunization Consent form from your healthcare provider or online.
2. Read the information provided in the form regarding the vaccines, including potential benefits and risks.
3. Fill in your personal information, such as your name, date of birth, and contact details.
4. Indicate if you have any allergies or pre-existing health conditions that may affect the vaccination.
5. Sign and date the consent form, acknowledging that you understand the information provided and agree to receive the vaccines.
6. Submit the completed consent form to your healthcare provider prior to receiving the immunization.

Who needs Canada Seasonal Influenza and Pneumococcal Immunization Consent?

1. Individuals who are recommended to receive seasonal influenza and pneumococcal vaccinations, including older adults, pregnant women, and those with chronic health conditions.
2. Healthcare workers and caregivers who may be in contact with high-risk populations.
3. Anyone in close contact with individuals at high risk of influenza or pneumonia complications.

People Also Ask about

What are the current pneumonia vaccine guidelines?

CDC recommends routine administration of pneumococcal conjugate vaccine (PCV15 or PCV20) for all adults 65 years or older who have never received any pneumococcal conjugate vaccine or whose previous vaccination history is unknown: If PCV15 is used, this should be followed by a dose of PPSV23 one year later.

Is PCV13 no longer recommended?

Two new pneumococcal conjugate vaccines (PCV15 and PCV20) are now recommended as pneumococcal vaccination options for all adults age 65 and older and for adults age 19 through 64 with certain medical conditions or other risk factors for pneumococcal disease; ACIP no longer recommends PCV13 for adults.

What is replacing Prevnar 13?

PREVNAR 20® is Pfizer's next-generation pneumococcal conjugate vaccine that includes capsular polysaccharide conjugates for the 13 serotypes (1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F and 23F) already included in Prevnar 13® (Pneumococcal 13-valent Conjugate Vaccine [Diphtheria CRM197 Protein]).

Why is PCV13 no longer recommended?

Because PCV13-type disease is at historically low levels among adults ≥65 years and most pneumococcal disease among these adults is due to non-PCV13 serotypes, ACIP no longer recommends their routine vaccination with PCV13.

Should I get pneumonia vaccine yes or no?

Studies* show that getting at least 1 shot of PCV13 protects: At least 8 in 10 babies from serious infections called invasive pneumococcal disease. 3 in 4 adults 65 years or older against invasive pneumococcal disease. 9 in 20 adults 65 years or older against pneumococcal pneumonia.

Do you need both Prevnar 13 and Pneumovax 23?

The Centers for Disease Control and Prevention ( CDC ) recommends that adults 65 years of age or older receive a single dose of Prevnar 13 in addition to the Pneumovax. Prevnar 13 should be given first and the Pneumovax a year later.

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What is Canada Seasonal Influenza and Pneumococcal Immunization Consent?

Canada Seasonal Influenza and Pneumococcal Immunization Consent is a document that individuals must sign to authorize the administration of seasonal influenza and pneumococcal vaccines. It serves to inform patients about the benefits and risks associated with these vaccinations.

Who is required to file Canada Seasonal Influenza and Pneumococcal Immunization Consent?

Individuals receiving seasonal influenza and pneumococcal vaccines are required to file this consent. This includes both adults and guardians of minors who are getting vaccinated.

How to fill out Canada Seasonal Influenza and Pneumococcal Immunization Consent?

To fill out the consent form, individuals need to provide personal information such as their name, date of birth, and contact information. They must also indicate any medical history and allergies, and then sign the form to confirm their understanding and consent.

What is the purpose of Canada Seasonal Influenza and Pneumococcal Immunization Consent?

The purpose of the consent is to ensure that individuals are informed about the vaccines, their benefits, and potential side effects. It is a legal requirement that protects both the healthcare provider and the patient.

What information must be reported on Canada Seasonal Influenza and Pneumococcal Immunization Consent?

The information that must be reported includes the individual's name, the type of vaccine being administered, consent date, any known allergies, medical conditions, and the signature of the individual or their guardian.