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INJECTABLE INFLUENZA VACCINE CONSENT FORM (WRITTEN) CLIENT INFORMATIONComplete Sections 1, 2, and 3 (please print)Last Name:First Name:Date of Birth (YYY/MM/DD):Address:Telephone Number:Emergency
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How to fill out injectable influenza vaccine

How to fill out injectable influenza vaccine
01
Make sure you have a sterile syringe and needle.
02
Check the vaccine vial for expiration date and visual abnormalities.
03
Clean the rubber seal of the vial with an alcohol swab.
04
Withdraw the required amount of vaccine into the syringe.
05
Choose an appropriate injection site, usually the upper arm or thigh.
06
Clean the injection site with an alcohol swab.
07
Hold the syringe like a pencil and insert the needle into the skin at a 90-degree angle.
08
Slowly push the plunger to inject the vaccine.
09
Remove the needle from the skin and discard it in a sharps container.
10
Apply pressure to the injection site with a sterile cotton ball.
11
Dispose of all used materials properly.
12
Make a note of the date and location of the injection for future reference.
Who needs injectable influenza vaccine?
01
Children aged 6 months to 19 years.
02
Adults aged 50 years and older.
03
Pregnant women.
04
Individuals with chronic health conditions like asthma, diabetes, or heart disease.
05
Healthcare workers.
06
Caregivers of high-risk individuals (e.g. infants, elderly, immunocompromised).
07
People living in long-term care facilities.
08
People who travel frequently and come into contact with others from different regions.
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What is injectable influenza vaccine?
Injectable influenza vaccine is a type of flu vaccine that is administered through a needle into the muscle.
Who is required to file injectable influenza vaccine?
Healthcare providers are required to file injectable influenza vaccine for their patients, especially those at high risk for flu complications.
How to fill out injectable influenza vaccine?
To fill out injectable influenza vaccine, healthcare providers need to document the vaccine administration date, dosage, brand, lot number, and patient information.
What is the purpose of injectable influenza vaccine?
The purpose of injectable influenza vaccine is to protect individuals from contracting the flu virus and reduce the severity of flu symptoms if infection occurs.
What information must be reported on injectable influenza vaccine?
The information that must be reported on injectable influenza vaccine includes the vaccine administration date, dosage, brand, lot number, and patient demographics.
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