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This document is a record for administering the influenza vaccine, confirming the individual's understanding and consent for the vaccine, and collecting personal information for health record and

How to fill out influenza vaccine administration record

How to fill out Influenza Vaccine Administration Record

1. Obtain a blank Influenza Vaccine Administration Record form.
2. Fill in the patient's personal information, including name, date of birth, and contact details.
3. Document the date of the vaccination.
4. Specify the type of influenza vaccine administered (e.g., seasonal, high-dose).
5. Enter the lot number and expiration date of the vaccine.
6. Record the site of the injection (e.g., left arm, right thigh).
7. Provide the name and title of the healthcare provider administering the vaccine.
8. Sign and date the form to complete the record.

Who needs Influenza Vaccine Administration Record?

1. Healthcare providers administering the influenza vaccine.
2. Patients receiving the influenza vaccine as proof of vaccination.
3. Public health officials tracking vaccination coverage.
4. Employers requiring vaccination records for workplace health compliance.

People Also Ask about

How to get immunization records translated?

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How do you document the administration of the flu vaccine?

Medical record: Record the date the vaccine was administered, the manufacturer and lot number, the vaccination site and route, and the name and address and, if appropriate, the title of the person administering the vaccine.

What should be documented after administering an injection?

Procedure note documentation requirements include: Diagnosis or indication for injection. Site of injection, eye(s) treated. Medication name, how much was injected (in milligrams and volume in milliliters) and lot number. How much of a drug is wasted. Route of administration.

How do you bill flu vaccine and 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 DD Form 2766c vaccine administration record?

The DD Form 2766, also known as the Adult Preventive and Chronic Conditions Worksheet, is typically completed by military personnel who are on active duty. It is used to assess the health and medical history of the individual, and to identify any preventive or chronic conditions that require treatment or monitoring.

What is the mode of administration of the flu shot?

For adults 19 years of age and older, the deltoid muscle in the upper arm is the preferred site, although the vastus lateralis muscle in the anterolateral thigh may be used if the deltoid site cannot be used. Influenza vaccines are not highly viscous, so a fine-gauge (22- to 25-gauge) needle can be used.

What should be documented when administering a vaccine?

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.

How to document a flu shot?

Job Aid Date of administration. Vaccine manufacturer. Vaccine lot number. Name and title of the person who administered the vaccine and address of the facility where the permanent record will reside. Vaccine information statement (VIS) Date printed on the VIS. Date the VIS was given to the patient or parent/guardian.

For pdfFiller’s FAQs

What is Influenza Vaccine Administration Record?

The Influenza Vaccine Administration Record is a document used to record the administration of the influenza vaccine to patients. It contains essential details about the vaccine, patient, and administration date.

Who is required to file Influenza Vaccine Administration Record?

Healthcare providers who administer the influenza vaccine are required to file the Influenza Vaccine Administration Record, including clinics, hospitals, and pharmacies.

How to fill out Influenza Vaccine Administration Record?

To fill out the Influenza Vaccine Administration Record, a healthcare provider must enter the patient's information, date of administration, vaccine lot number, expiration date, site of administration, and the provider's signature or initials.

What is the purpose of Influenza Vaccine Administration Record?

The purpose of the Influenza Vaccine Administration Record is to ensure proper documentation of vaccinations for tracking, reporting, and follow-up purposes, as well as to maintain patient safety.

What information must be reported on Influenza Vaccine Administration Record?

The information that must be reported on the Influenza Vaccine Administration Record includes the patient's name, date of birth, date of administration, vaccine type, lot number, expiration date, site of administration, and the name of the administering provider.