Canada Rexall FluShot Patient Consent for Flu (Influenza) Immunization 2018 free printable template
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Flush
Date:Influenza (Flu) Informed Consent provincial legislation, Pharmacists cannot administer a flu shot to
children under a certain age. Ask your pharmacist for age restrictions.
Provincial
Health
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How to fill out Canada Rexall FluShot Patient Consent for Flu (Influenza)
01
Obtain the Canada Rexall FluShot Patient Consent for Flu (Influenza) form from a Rexall pharmacy or their website.
02
Read the information on the form carefully to understand the purpose and importance of the flu shot.
03
Fill in your personal information, including your full name, date of birth, and contact details.
04
Indicate any relevant medical history, such as allergies or previous reactions to vaccines.
05
Review the consent statements and ensure you understand the risks and benefits of the flu vaccine.
06
Sign and date the form to acknowledge your consent to receive the flu shot.
07
Submit the completed form to the pharmacy staff when you arrive for your appointment.
Who needs Canada Rexall FluShot Patient Consent for Flu (Influenza)?
01
Individuals aged 6 months and older who are seeking a flu vaccination.
02
People with chronic health conditions or weakened immune systems who are at higher risk for flu complications.
03
Healthcare workers and caregivers who are in close contact with vulnerable populations.
04
Anyone wanting to reduce their risk of contracting or spreading influenza.
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What is Canada Rexall FluShot Patient Consent for Flu (Influenza)?
Canada Rexall FluShot Patient Consent for Flu (Influenza) is a document that patients must complete to provide informed consent before receiving the influenza vaccine at Rexall pharmacies in Canada.
Who is required to file Canada Rexall FluShot Patient Consent for Flu (Influenza)?
Any individual receiving the flu vaccine at a Rexall pharmacy is required to fill out and file the Canada Rexall FluShot Patient Consent for Flu (Influenza).
How to fill out Canada Rexall FluShot Patient Consent for Flu (Influenza)?
To fill out the Canada Rexall FluShot Patient Consent for Flu (Influenza), patients need to provide personal information, including their name, date of birth, and health history, along with their consent to receive the vaccine.
What is the purpose of Canada Rexall FluShot Patient Consent for Flu (Influenza)?
The purpose of the Canada Rexall FluShot Patient Consent for Flu (Influenza) is to ensure that patients are informed about the vaccine, its benefits and risks, and to obtain their consent to administer the vaccine.
What information must be reported on Canada Rexall FluShot Patient Consent for Flu (Influenza)?
The information that must be reported on the Canada Rexall FluShot Patient Consent for Flu (Influenza) includes the patient's personal details, any allergies or medical conditions, and confirmation of understanding the information provided.
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