Get the free 2010-2011 SEASONAL INFLUENZA CONSENT FORM - freeman k12 sd
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This form is used to obtain consent for influenza vaccination for children, detailing personal information of the child, parent, and vaccination details, along with privacy practices regarding immunization
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How to fill out 2010-2011 seasonal influenza consent
How to fill out 2010-2011 SEASONAL INFLUENZA CONSENT FORM
01
Obtain the 2010-2011 Seasonal Influenza Consent Form from your healthcare provider or the appropriate health authority.
02
Read through the information provided on the form carefully to understand the purpose of the vaccination.
03
Fill in your personal information, including your name, date of birth, and contact details if required.
04
Answer any health-related questions, such as current medications or allergies, to ensure the vaccine is safe for you.
05
Sign the consent section of the form to indicate that you agree to receive the influenza vaccine.
06
Submit the completed form to the healthcare professional administering the vaccine.
Who needs 2010-2011 SEASONAL INFLUENZA CONSENT FORM?
01
Individuals seeking vaccination against seasonal influenza for the 2010-2011 season, including children, adults, and those with specific health conditions.
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People Also Ask about
What is seasonal influenza vaccination?
Flu vaccines cause antibodies to develop in the body about two weeks after vaccination. These antibodies provide protection against flu illness. Seasonal flu vaccines are designed to protect against the influenza viruses that research indicates will be most common during the upcoming season.
When documenting the administration of a vaccine, what information should be included?
What information does federal law require us to document when we immunize a patient? The vaccine manufacturer. The lot number of the vaccine. The date the vaccine is administered. The name, office address, and title of the healthcare provider administering the vaccine.
How to code vaccine administration?
In the absence of counseling, the administrations must be reported with codes 90471-90474. 90460-90461 are reported for administration to patients 18 years of age and under. Code 90460 is reported for each separate administration of single component vaccines and/or first component of a combination vaccine.
What is the difference between 90657 and 90658?
90657 - Influenza virus vaccine, trivalent (IIV3), split virus, 0.25-mL dosage, for intramuscular use. 90658 - Influenza virus vaccine, trivalent (IIV3), split virus, 0.5-mL dosage, for intramuscular use. Source: 2024 CPT. A maximum of 10 doses can be withdrawn from the multi-dose vial.
How to document vaccine administration?
By law, the following information must be documented on the patient's paper or electronic medical record (or on a permanent office log): The vaccine manufacturer. The lot number of the vaccine. The date the vaccine is administered.
What vaccines were given in 2010?
2000 Recommended Vaccines. Diphtheria* Tetanus* Pertussis* Measles** Mumps** Rubella** Polio (IPV) Hib. 2005 Recommended Vaccines. Diphtheria* Tetanus* Pertussis* Measles** Mumps** Rubella** Polio (IPV) Hib. 2010 Recommended Vaccines. Diphtheria* Tetanus* Pertussis* Measles** Mumps** Rubella** Polio (IPV) Hib.
How do you document the administration of the flu vaccine?
All vaccines administered should be fully documented in the patient's permanent medical record. Health care providers who administer vaccines that are covered by the National Vaccine Injury Compensation Program are required by law to ensure the permanent medical record of the recipient indicates: Date of administration.
What information must vaccine administration document in a patient's medical record?
The medical record must contain evidence of the vaccination administration to include the Manufacturer Lot # and Expiration Date as well as the publication date of the vaccine information sheet (VIS) given to the patient.
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What is 2010-2011 SEASONAL INFLUENZA CONSENT FORM?
The 2010-2011 Seasonal Influenza Consent Form is a document that individuals must complete to give consent for receiving the seasonal influenza vaccine during the specified season.
Who is required to file 2010-2011 SEASONAL INFLUENZA CONSENT FORM?
Individuals, typically including patients, parents, or guardians of minors, who wish to receive the seasonal influenza vaccine are required to file the 2010-2011 Seasonal Influenza Consent Form.
How to fill out 2010-2011 SEASONAL INFLUENZA CONSENT FORM?
To fill out the form, individuals need to provide personal information, such as name and date of birth, confirm understanding of the vaccine information, and sign to indicate consent for vaccination.
What is the purpose of 2010-2011 SEASONAL INFLUENZA CONSENT FORM?
The purpose of the form is to ensure that individuals are informed about the vaccine, understand any risks involved, and have formally agreed to receive the seasonal influenza vaccine.
What information must be reported on 2010-2011 SEASONAL INFLUENZA CONSENT FORM?
The information that must be reported includes the individual's personal details, any relevant medical history, acknowledgment of understanding vaccine information, and consent signature.
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