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INFLUENZA (IIT/RIV) VACCINE CONSENT FORM AND ADMINISTRATION RECORD 20202021 Whip/AFC Eligibility: MedicaidUninsuredUnderinsuredInsuredNative/Alaskan American WY ResidentNonResidentInformation about

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How to fill out immunization - vaccines for

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Make sure to have a record of current immunization schedule for reference.

02

Fill out the patient's personal information such as name, date of birth, and contact details.

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Indicate the type of vaccine being administered and the date of administration.

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Note down any adverse reactions or side effects experienced by the patient.

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Document the name and license number of the healthcare professional administering the vaccine.

Who needs immunization - vaccines for?

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Immunization vaccines are recommended for infants, children, adolescents, and adults to protect against various infectious diseases.

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People with weakened immune systems or certain medical conditions may require immunizations to prevent serious complications.

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What is immunization - vaccines for?

Immunization - vaccines are for protecting individuals against certain diseases by triggering the immune system to create antibodies.

Who is required to file immunization - vaccines for?

Individuals of all ages, depending on the vaccine recommendations from health authorities.

How to fill out immunization - vaccines for?

Immunization records can be filled out by healthcare providers or individuals themselves, documenting the vaccines received.

What is the purpose of immunization - vaccines for?

The purpose of immunization - vaccines is to prevent the spread of infectious diseases and protect individuals and communities.

What information must be reported on immunization - vaccines for?

Information such as the type of vaccine received, date of vaccination, and the person's name and identification may need to be reported on immunization records.

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