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UNIVERSITY1111OJVIRGINIADepartment of Student Health and WellnessMeningococcal Vaccine Waiver Student Name: ___ University ID: ___ Date of Birth: ___/___/___ I have reviewed the information (https://www.immunize.org/vis/meningococcal_acwy.pdf)

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How to fill out vaccine information statements

01

Obtain the vaccine information statement from the healthcare provider administering the vaccine.

02

Read the statement carefully, paying attention to the information about the specific vaccine being given, including potential side effects and risks.

03

Fill out any required personal information, such as name, date of birth, and medical history.

04

Sign and date the statement to indicate that you have received and understood the information provided.

05

Keep a copy of the completed vaccine information statement for your records.

Who needs vaccine information statements?

01

Vaccine information statements are typically needed by individuals who are receiving vaccines, particularly in a healthcare setting. This includes patients, parents or guardians of minors receiving vaccines, and healthcare providers administering vaccines.

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What is vaccine information statements?

Vaccine information statements inform patients and/or their parents or guardians about the benefits and risks of a vaccine before receiving it.

Who is required to file vaccine information statements?

Healthcare providers who administer vaccines are required to provide vaccine information statements to patients or their parents or guardians.

How to fill out vaccine information statements?

Vaccine information statements can be filled out by healthcare providers by providing specific information about the administered vaccine, including its benefits, risks, and potential side effects.

What is the purpose of vaccine information statements?

The purpose of vaccine information statements is to ensure that patients or their parents or guardians are informed about the benefits and risks of vaccines before receiving them.

What information must be reported on vaccine information statements?

Vaccine information statements must include details about the specific vaccine being administered, its benefits, potential risks and side effects, and how to report any adverse reactions.

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