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20182019 Influenza and/or Pneumococcal Vaccine Patient Form Wayne County Health Dept. PLEASE PROVIDE INSURANCE CARD217 Ken ova Avenue Wayne, WV 25570 (304) 2726761 CHECK IF NO INSURANCE Personal Information

How to fill out 2018-2019 influenza andor pneumococcal

How to fill out 2018-2019 influenza andor pneumococcal

1. To fill out the 2018-2019 influenza and/or pneumococcal forms, follow these steps:
2. Obtain the required forms from your healthcare provider or local health department.
3. Read and understand the instructions provided with the forms.
4. Fill in your personal information accurately, including your name, date of birth, and contact details.
5. Provide information about your medical history, including any previous vaccinations, allergies, or chronic conditions.
6. Answer all the questions on the forms related to influenza and/or pneumococcal vaccines.
7. If applicable, indicate if you have any contraindications or concerns regarding the vaccines.
8. Sign and date the forms to confirm that the information provided is true and accurate.
9. Submit the completed forms to your healthcare provider or local health department as instructed.
10. Keep a copy of the filled-out forms for your records.

Who needs 2018-2019 influenza andor pneumococcal?

1. The 2018-2019 influenza and/or pneumococcal vaccines are recommended for the following individuals:
2. - Anyone aged six months and older, particularly those at high risk of complications from influenza or pneumococcal infections.
3. - Pregnant women, as they are more susceptible to severe illness from the flu.
4. - Young children and infants, as they have a higher risk of developing serious complications from these infections.
5. - Older adults (65 years and above) who are more prone to severe flu symptoms and complications.
6. - Individuals with certain chronic medical conditions, such as asthma, diabetes, heart disease, or weakened immune systems.
7. - Healthcare workers and caregivers, as they are regularly exposed to infected individuals and can transmit the flu or pneumococcal bacteria to vulnerable populations.
8. - Anyone who wants to reduce their risk of contracting or spreading the influenza or pneumococcal infections.
9. It is important to consult with your healthcare provider for personalized advice regarding vaccination and any specific eligibility criteria.

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What is influenza andor pneumococcal vaccine?

The influenza vaccine is designed to protect against the flu, a contagious respiratory illness caused by influenza viruses. The pneumococcal vaccine protects against pneumonia and other infections caused by Streptococcus pneumoniae bacteria.

Who is required to file influenza andor pneumococcal vaccine?

Individuals at higher risk, such as the elderly, young children, and those with certain health conditions, are encouraged to receive these vaccines. Health care providers and organizations may also have requirements to report vaccination data.

How to fill out influenza andor pneumococcal vaccine?

To fill out vaccination forms, one typically needs to provide personal information, vaccination dates, vaccine type, and the administering provider’s details. It's important to follow local health department guidelines for accurate reporting.

What is the purpose of influenza andor pneumococcal vaccine?

The purpose of these vaccines is to prevent specific diseases: the influenza vaccine reduces the risk of flu infection and its complications, while the pneumococcal vaccine prevents pneumococcal disease, which includes pneumonia, meningitis, and bloodstream infections.

What information must be reported on influenza andor pneumococcal vaccine?

Reported information typically includes the patient's name, date of birth, vaccine type, administration date, and the name and address of the provider who administers the vaccine.