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2020 2021 INFLUENZA VACCINE CONSENT AND SCREENING FORM Injectable (Flu Shot) Information about the person to receive vaccine (please print): Name: (Last, First, MI)Date of birth: MonthDayAgeSex: (Circle)
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How to fill out injectable flu shot

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How to fill out injectable flu shot

01
Gather all necessary materials such as the flu shot vial, alcohol swab, and syringe.
02
Wash your hands thoroughly with soap and water.
03
Remove the cap from the flu shot vial and wipe the rubber stopper with an alcohol swab.
04
Take the prefilled syringe and remove the cap, being careful not to touch the needle.
05
Insert the needle into the rubber stopper of the flu shot vial and push the plunger down to inject air into the vial.
06
Withdraw the appropriate dose of the flu vaccine into the syringe as directed by your healthcare professional.
07
Gently tap the syringe to remove any air bubbles and carefully push the plunger to expel the air.
08
Choose an injection site, typically the upper arm or thigh, and clean it with an alcohol swab.
09
Pinch the skin at the injection site and insert the needle at a 90-degree angle.
10
Slowly and steadily push the plunger until the entire dose has been injected.
11
Remove the needle from the skin and apply gentle pressure with a sterile cotton ball or bandage.
12
Dispose of the used syringe and any remaining flu vaccine following proper medical waste disposal guidelines.
13
Wash your hands again with soap and water.
14
Record the date, time, and location of the injection for future reference.

Who needs injectable flu shot?

01
The injectable flu shot is recommended for:
02
- Children aged 6 months and older
03
- Adults of all ages
04
- Pregnant women
05
- Individuals with chronic medical conditions such as asthma, diabetes, or heart disease
06
- Healthcare workers
07
- Caregivers of young children or elderly individuals
08
- Individuals living in long-term care facilities
09
- Individuals traveling to areas with flu outbreaks
10
It is advisable to consult with your healthcare professional to determine if the injectable flu shot is appropriate for your specific situation.
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The injectable flu shot is a vaccine administered by injection that protects against influenza by stimulating the immune system to produce antibodies against the virus.
Healthcare providers administering flu shots are typically required to file records of their administration with appropriate health authorities.
To fill out an injectable flu shot record, document the patient's information, date of administration, vaccine type, dosage, manufacturer, lot number, and the administering provider's information.
The purpose of the injectable flu shot is to provide immunity against the influenza virus, reducing the risk of infection and the severity of illness if infected.
The information that must be reported includes patient details, vaccine type, date of administration, dosage, manufacturer, lot number, and the name of the provider who administered the shot.
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