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Texas Department of State Health Services Addendum to Inactivated Influenza Vaccine Vaccine Information Statement 1. Instructions File this consent statement in the patient s chart. C-93 08/2015 CDC VIS Revision 08/07/15. 5. I have had a chance to ask questions about the disease the vaccine prevents the vaccine and how the vaccine is given. 6. Notice Alterations or changes to this publication is prohibited without the express written consent of the Texas Department of State Health Services...

How to fill out addendum to influenza vaccine

How to fill out addendum to influenza vaccine:

1. Obtain the addendum form from your healthcare provider or the vaccination center.
2. Carefully read the instructions and information provided on the addendum form.
3. Start by filling out your personal information accurately, including your full name, date of birth, and contact details.
4. Provide information about your previous influenza vaccine, such as the date of vaccination, the type of vaccine received, and the name of the healthcare provider or vaccination center.
5. If you experienced any adverse reactions or side effects from the previous influenza vaccine, make sure to indicate them clearly on the form.
6. If applicable, provide any additional information or medical history that may be relevant to your influenza vaccination.
7. Review the completed addendum form to ensure that all the information provided is accurate and legible.
8. Sign and date the form, confirming that the information you provided is true and accurate to the best of your knowledge.
9. Return the completed addendum form to your healthcare provider or the vaccination center as instructed.

Who needs addendum to influenza vaccine:

1. Individuals who have previously received an influenza vaccine and need to provide additional information or update their vaccination records.
2. Those who have experienced adverse reactions or side effects from a previous influenza vaccine and need to report these incidents for future reference.
3. Individuals who have a specific medical condition or history that may require additional documentation or information regarding their influenza vaccination.

People Also Ask about

What is the admin CPT code for flu vaccine?

90688=Inactivated quadrivalent influenza vaccine (IIV4), split virus, 0.5-mL dosage, for intramuscular use. Source: 2021 CPT.

What is the CDC statement on flu vaccine?

CDC recommends everyone 6 months of age and older should receive an annual flu vaccination with rare exceptions.

How to opt out of the flu vaccine?

Vaccine Declination. Covered Individuals who choose to decline influenza vaccination must complete a Vaccine Declination Letter and submit it to the location vaccine authority on or before December 1, 2022.

What is CPT 90461 and 90471?

CPT® range 90471 — 90474 identifies vaccines without Counseling (over 18 years of age) CPT® range 90460 — 90461 identifies vaccines with Counseling (thru age 18)

What is 90686 CPT with admin code?

90686 Influenza virus vaccine, quadrivalent, split virus, preservative free, 0.5 ml dosage, for intramuscular use 90696 Diphtheria, tetanus toxoids, acellular pertussis vaccine and poliovirus vaccine, inactivated (DTaP-IPV), when administered to children 4 years through 6 years of age, for intramuscular use.

What is the VIS form and what responsibility does the MA have with it?

A VIS or Vaccine Information Statement is a document, produced by CDC, that informs vaccine recipients – or their parents or legal representatives – about the benefits and risks of a vaccine they are receiving.

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What is addendum to influenza vaccine?

An addendum to the influenza vaccine is a supplementary document that provides additional information or clarifications related to the administration of the influenza vaccine.

Who is required to file addendum to influenza vaccine?

Healthcare providers or organizations that administer the influenza vaccine may be required to file an addendum if there are specific updates or changes to vaccine administration protocols or reporting.

How to fill out addendum to influenza vaccine?

To fill out an addendum to the influenza vaccine, providers must include relevant details such as patient information, vaccine lot numbers, administration dates, and any specific notes regarding the vaccine administration.

What is the purpose of addendum to influenza vaccine?

The purpose of the addendum is to ensure accurate reporting and record-keeping related to the influenza vaccine, facilitating better tracking of vaccine efficacy and safety.

What information must be reported on addendum to influenza vaccine?

The information that must be reported includes patient identification details, vaccine brand/type, lot number, expiration date, administration date, location of administration, and any relevant adverse reactions.