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FOR OFFICE USE ONLY Dosage/Location Date 0. 5cc RD LD Manufacturer/ LOT /Exp. Date GSK Y9H77 EXP. 4/17 OR Provider Signature. Do you currently have an acute illness with fever 2. Do you have an allergy to eggs or to a component of the vaccine 3. Have you ever had a serious reaction to influenza vaccine in the past I have read or had explained to me the Center for Disease Control Information Sheet VIS and I hereby authorize Kent State University Health Services to give me the FLU VACCINE....
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How to fill out flu vaccine informed consent

01
Read and understand the flu vaccine informed consent form.
02
Obtain the form from a healthcare provider or vaccination center.
03
Fill in your personal information, including name, age, and contact details.
04
Review the risks and benefits section thoroughly.
05
Indicate any allergies or previous reactions to vaccines, if applicable.
06
Sign and date the informed consent form.
07
Return the completed form to the healthcare provider or vaccination center.

Who needs flu vaccine informed consent?

01
Anyone who wishes to receive a flu vaccine should fill out an informed consent form.
02
This includes individuals of all ages, from children to adults.
03
People with specific medical conditions or allergies should be especially careful in providing accurate information on the form.
04
Parents or legal guardians must fill out the form for minors.
05
Healthcare workers administering the vaccine may also be required to complete an informed consent form.
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Flu vaccine informed consent is a form or document that must be signed by an individual or their legal guardian before receiving a flu vaccine. It confirms that the individual understands the risks and benefits of the vaccine.
Any individual receiving a flu vaccine or their legal guardian is required to file flu vaccine informed consent.
Flu vaccine informed consent can be filled out by providing personal information, acknowledging understanding of the risks and benefits of the vaccine, and signing the document.
The purpose of flu vaccine informed consent is to ensure that individuals are informed about the risks and benefits of receiving a flu vaccine before they consent to vaccination.
Flu vaccine informed consent typically includes information about the vaccine, potential side effects, the individual's medical history, and consent to receive the vaccine.
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