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Admission Checklist Influenza and Pneumococcal Immunization×Resident:Room#: Assessed by:Date: Influenza Vaccine (given October March) Pneumococcal Vaccine (offered year round) Considered high risk
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How to fill out influenza and pneumococcal immunization

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How to fill out influenza and pneumococcal immunization

01
To fill out influenza immunization, follow these steps:
02
Make sure you have the necessary information and documentation, such as your identification and medical history.
03
Visit a healthcare provider or a vaccination clinic that offers influenza immunization.
04
Provide your personal information and consent for the immunization.
05
Answer any questions related to your health or any possible allergies.
06
Roll up your sleeves or expose the area where the vaccine will be administered.
07
The healthcare provider will clean the area with an antiseptic swab.
08
The vaccine will be injected either into your arm muscle or your upper thigh muscle, depending on your preference and the healthcare provider's recommendation.
09
After the injection, remain at the vaccination site for a short observation period to ensure you have no immediate adverse reactions.
10
Receive your vaccination record or any necessary information about potential side effects or follow-up care.
11
To fill out pneumococcal immunization, follow these steps:
12
Gather your medical and identification information.
13
Schedule an appointment with a healthcare provider or visit a vaccination clinic that offers pneumococcal immunization.
14
Provide your personal information and consent for the immunization.
15
Answer any questions related to your health or any possible allergies.
16
Roll up your sleeves or expose the area where the vaccine will be administered.
17
The healthcare provider will clean the area with an antiseptic swab.
18
The vaccine will be injected into your arm muscle.
19
After the injection, remain at the vaccination site to ensure you have no immediate adverse reactions.
20
Receive your vaccination record or any necessary information about potential side effects or follow-up care.

Who needs influenza and pneumococcal immunization?

01
Influenza immunization is recommended for:
02
- Children above 6 months of age
03
- Adults over the age of 50
04
- Pregnant women
05
- Individuals with chronic medical conditions
06
- Healthcare workers and caregivers
07
Pneumococcal immunization is recommended for:
08
- Infants and young children
09
- Adults over the age of 65
10
- Individuals with weakened immune systems
11
- Individuals with certain chronic medical conditions
12
- Smokers

What is Influenza and Pneumococcal Immunization* Form?

The Influenza and Pneumococcal Immunization* is a document that should be submitted to the specific address in order to provide certain info. It must be filled-out and signed, which may be done manually in hard copy, or using a particular solution such as PDFfiller. It lets you complete any PDF or Word document directly from your browser (no software requred), customize it according to your purposes and put a legally-binding electronic signature. Once after completion, user can send the Influenza and Pneumococcal Immunization* to the relevant individual, or multiple individuals via email or fax. The template is printable as well thanks to PDFfiller feature and options proposed for printing out adjustment. In both electronic and physical appearance, your form will have got clean and professional look. It's also possible to save it as the template to use it later, so you don't need to create a new blank form again. All you need to do is to amend the ready template.

Template Influenza and Pneumococcal Immunization* instructions

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Influenza and pneumococcal immunization are vaccines that help protect against the flu and pneumococcal disease.
Individuals who are at risk of complications from the flu or pneumococcal disease are usually required to get vaccinated and file immunization records.
You can fill out influenza and pneumococcal immunization forms at doctor's offices, pharmacies, or clinics where the vaccines are administered.
The purpose of influenza and pneumococcal immunization is to prevent illness, hospitalizations, and deaths caused by the flu and pneumococcal disease.
Information such as the type of vaccine received, date of vaccination, and the healthcare provider who administered the vaccine must be reported on immunization records.
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