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Meningococcal A, C, Y, W135 Vaccine Consent Form INSTRUCTIONS FOR PARENT 1. Read the attached information about the Meningococcal vaccine. 2. Remove the consent form. Complete the front of this page.

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What is meningococcal a c y?

Meningococcal ACY refers to a vaccine that helps prevent meningococcal disease caused by serogroups A, C, and Y bacteria.

Who is required to file meningococcal a c y?

Individuals who are at risk or recommended by healthcare providers to receive the meningococcal ACY vaccine are required to file it.

How to fill out meningococcal a c y?

The meningococcal ACY vaccine can be filled out by a healthcare provider during a routine vaccination appointment.

What is the purpose of meningococcal a c y?

The purpose of meningococcal ACY vaccine is to protect individuals from the meningococcal disease caused by serogroups A, C, and Y bacteria.

What information must be reported on meningococcal a c y?

Information such as the date of vaccination, type of vaccine administered, and the healthcare provider's details must be reported on the meningococcal ACY form.

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