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201718 STUDENT INFLUENZA VACCINATION CONSENT FORM INACTIVATED INFLUENZA (IIT) ONLY Health Department Use Only CI #: Encounter #: Receipt #: Name: Lactate of Birth:/First/Age:If minor parent/guardians
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How to fill out inactivated influenza iiv only
How to fill out inactivated influenza iiv only
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To fill out inactivated influenza (iiv) form, follow these points:
02
Start by gathering all the necessary information such as your personal details, medical history, and any previous vaccinations received.
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Read the instructions carefully and make sure you understand the purpose and requirements of the form.
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Begin by providing your full name, date of birth, and contact information.
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Move on to the medical history section and answer questions regarding any current medical conditions and allergies.
06
Provide details of any medications you are currently taking.
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Next, indicate whether you have received any previous influenza vaccinations and provide the dates of administration.
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If you have any concerns or questions, consult your healthcare provider before proceeding.
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Finally, review and double-check all the information you have provided to ensure accuracy and completeness.
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Sign and date the form to confirm your consent for receiving the inactivated influenza vaccine.
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Submit the completed form to the appropriate healthcare provider or vaccination center.
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Remember to follow any additional instructions or guidelines provided by the healthcare professional administering the vaccine.
Who needs inactivated influenza iiv only?
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Inactivated influenza (iiv) vaccine is recommended for the following individuals:
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- Anyone aged 6 months and older who wants to reduce their risk of getting influenza and its complications.
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- Individuals with chronic health conditions such as asthma, diabetes, heart disease, and immunosuppression.
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- Pregnant women and those planning to become pregnant during flu season.
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- Older adults aged 65 years and older.
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- Healthcare workers and caregivers.
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- Residents of long-term care facilities.
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- Individuals traveling to areas with a higher risk of influenza outbreaks.
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It is important to consult with your healthcare provider to determine if the inactivated influenza vaccine is suitable for you or if you have any specific concerns.
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What is inactivated influenza iiv only?
Inactivated influenza IIV only refers to the inactive form of the influenza vaccine.
Who is required to file inactivated influenza iiv only?
Typically, healthcare providers and facilities are required to file inactivated influenza IIV only.
How to fill out inactivated influenza iiv only?
To fill out inactivated influenza IIV only, healthcare providers must document the administration of the vaccine and submit the necessary paperwork.
What is the purpose of inactivated influenza iiv only?
The purpose of inactivated influenza IIV only is to provide protection against the influenza virus.
What information must be reported on inactivated influenza iiv only?
Information such as the patient's name, date of vaccination, and vaccine lot number must be reported on inactivated influenza IIV only.
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