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20192020 INFLUENZA VACCINE CONSENT FORM POD Information about person to be vaccinated (please print)for children: office use ballast Name: Age: First Name: Child needs second doses: MF Date of Birth:

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How to fill out 2019-2020 -- influenza vaccine

01

Step 1: Visit a healthcare provider or a vaccination clinic that offers the 2019-2020 influenza vaccine.

02

Step 2: Provide your personal information, such as name, date of birth, and contact details, to the healthcare provider or clinic staff.

03

Step 3: Answer any questions about your medical history or previous experiences with vaccines.

04

Step 4: Review and sign any necessary consent forms.

05

Step 5: Roll up your sleeve and expose your upper arm for the injection.

06

Step 6: The healthcare provider will clean the injection site with an alcohol pad.

07

Step 7: Relax your arm and take deep breaths to stay calm.

08

Step 8: The healthcare provider will administer the vaccine using a needle and syringe. You may feel a slight pinch or stinging sensation.

09

Step 9: After the injection, apply pressure to the injection site with a cotton ball or gauze to minimize bleeding.

10

Step 10: Dispose of the needle and syringe in a designated sharps container.

11

Step 11: Thank the healthcare provider or clinic staff and schedule any necessary follow-up appointments.

Who needs 2019-2020 -- influenza vaccine?

01

The 2019-2020 influenza vaccine is recommended for almost everyone over the age of 6 months, including:

02

- Children

03

- Adults

04

- Pregnant women

05

- Elderly individuals

06

- Individuals with chronic health conditions

07

- Healthcare workers

08

- Caregivers of high-risk individuals

09

- Individuals traveling to areas with high flu activity

10

- Individuals living in crowded environments (e.g., college dormitories, nursing homes)

11

- Anyone who wants to reduce their risk of getting the flu or spreading it to others.

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