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Calvert County Health Department 2013-2014 SEASONAL Influenza Vaccination Consent Form Name: (Last, First and Middle Initial) Medicare Part B Number: Address (Street or PO Box): Age: Race: City: Date

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How to fill out 2013-2014 seasonal influenza vaccination

01

To fill out the 2013-2014 seasonal influenza vaccination, follow these steps:

1.1

Locate a healthcare provider or vaccination clinic that offers the vaccination.

1.2

Schedule an appointment or visit the designated location during the specified vaccination period.

1.3

Complete any necessary paperwork, such as consent forms or medical history questionnaires.

1.4

Provide accurate personal information, including your name, date of birth, and contact details.

1.5

Answer any relevant questions about your health or medical history that may impact the vaccination process.

1.6

Be prepared to discuss any allergies or previous adverse reactions to vaccines.

1.7

Follow the instructions given by the healthcare provider administering the vaccination, such as positioning your arm for the injection.

1.8

Remain at the vaccination site for the recommended observation period to ensure no immediate adverse effects occur.

1.9

Take note of any post-vaccination instructions, such as potential side effects and when to seek medical attention if necessary.

02

The 2013-2014 seasonal influenza vaccination is recommended for various individuals, including:

2.1

Those who fall within the high-risk group, which generally includes young children, pregnant women, older adults (65 years and above), and individuals with certain chronic medical conditions.

2.2

Healthcare workers who have a higher likelihood of exposure to the flu virus and can potentially transmit it to vulnerable populations.

2.3

Individuals who live with or care for people at high risk of flu-related complications, such as family members or caregivers of young children or immunocompromised individuals.

2.4

Anyone who wants to reduce their risk of contracting the seasonal flu or spreading it to others, as vaccination aids in preventing the spread of the virus within the community.

Remember, for specific recommendations based on your age, health condition, or individual circumstances, consult with a healthcare professional or refer to the guidelines provided by your local health department or the Centers for Disease Control and Prevention (CDC).

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What is seasonal influenza vaccination consent?

Seasonal influenza vaccination consent is a form or document that gives permission to administer the seasonal flu vaccine to an individual.

Who is required to file seasonal influenza vaccination consent?

Seasonal influenza vaccination consent is typically required for individuals who wish to receive the seasonal flu vaccine, especially in certain settings such as schools, workplaces, healthcare facilities, etc.

How to fill out seasonal influenza vaccination consent?

Seasonal influenza vaccination consent forms usually require the individual's personal information, medical history, consent to receive the vaccine, and signature.

What is the purpose of seasonal influenza vaccination consent?

The purpose of seasonal influenza vaccination consent is to ensure that individuals are informed about the vaccine, understand the potential risks and benefits, and provide consent for vaccination.

What information must be reported on seasonal influenza vaccination consent?

Seasonal influenza vaccination consent forms may require information such as name, date of birth, medical history, allergies, previous vaccinations, consent for vaccination, etc.

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