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Influenza Vaccine Consent/Declination Form 2021/2022Print Name: ___ Department: ___I had the opportunity to receive the CDC Vaccine Information Sheet (IS) regarding the influenza vaccine and I understand
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How to fill out flu shot influenza vaccine

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How to fill out flu shot influenza vaccine

01
Wash your hands with soap and water before handling the flu shot.
02
Check the package to ensure that the vaccine is not expired.
03
Clean the injection site with an alcohol swab.
04
Hold the syringe with one hand and remove the cap with the other hand.
05
Pinch the skin around the injection site to create a small fold.
06
Insert the needle into the fold of skin at a 90-degree angle.
07
Push the plunger of the syringe to inject the vaccine into the muscle.
08
After injecting the vaccine, remove the needle and apply pressure to the injection site with a cotton ball or bandage.
09
Dispose of the syringe and needle in a puncture-proof container.
10
Wash your hands again with soap and water.

Who needs flu shot influenza vaccine?

01
The flu shot influenza vaccine is recommended for everyone above the age of 6 months.
02
It is particularly important for individuals at higher risk of complications from the flu, such as pregnant women, young children, older adults, and individuals with certain medical conditions.
03
Healthcare workers, caregivers, and individuals who work or live in close proximity to people at high risk should also get the flu shot to protect themselves and those around them.

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The flu shot, or influenza vaccine, is an injectable vaccine that provides immunity against the influenza virus, helping to prevent flu-related illnesses and complications.
Individuals, particularly those in high-risk categories such as healthcare workers, elderly individuals, and people with chronic health conditions, are often encouraged or required to receive the flu shot annually.
To fill out the flu shot vaccine form, you typically need to provide personal information such as name, date of birth, and health history, along with details about the vaccination itself, including date of administration and the administering provider.
The purpose of the flu shot is to reduce the risk of contracting influenza, to minimize the severity of the illness if contracted, and to prevent the spread of the virus to others.
Information that must be reported includes the patient's name, date of birth, vaccination date, vaccine manufacturer, lot number, and the name of the healthcare provider administering the vaccine.
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