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ADULT INFLUENZA IMMUNIZATION CONSENT LE COM INSTITUTE FOR SUCCESSFUL AGING | 5535 Peach St., Erie, PA 16509 (814) 868 3883 SCREENING QUESTIONNAIRE FOR INJECTABLE INFLUENZA VACCINE 1. Has the Vaccine

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Be sure to read the consent form carefully and understand its contents.

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Fill in all required personal information accurately.

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Sign and date the consent form where indicated.

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Make a copy of the completed consent form for your records.

Who needs consent forms - lecom?

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Patients undergoing medical procedures or treatments at LECOM.

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Patients participating in clinical trials or research studies at LECOM.

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Minors who require parental or guardian consent for medical care at LECOM.

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What is consent forms - lecom?

Consent forms - lecom are documents that authorize the use of personal information for a specific purpose within the LECOM organization.

Who is required to file consent forms - lecom?

All employees and individuals affiliated with LECOM are required to file consent forms.

How to fill out consent forms - lecom?

Consent forms - lecom can be filled out electronically through the LECOM online portal or manually by filling out the paper forms provided by the organization.

What is the purpose of consent forms - lecom?

The purpose of consent forms - lecom is to ensure that individuals are aware of and give permission for the use of their personal information within the LECOM organization.

What information must be reported on consent forms - lecom?

Consent forms - lecom must include basic personal information, details of the information being used, the purpose of use, and any third parties involved.

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