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20222023 Seasonal Influenza (Flu) +/ COVID-19 Vaccine Consent Form Section 1: Patient Information Last Name:First Name:Phone Number:Prov. Health Number:Date of Birth (MM/DD/YYY):Gender: Male Age:

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How to fill out 2022-2023 seasonal influenza flu

01

Obtain the 2022-2023 seasonal influenza flu vaccine from a healthcare provider or pharmacy.

02

Read and follow the instructions provided with the vaccine.

03

Choose a clean and suitable location for administering the vaccine.

04

Clean the injection site with alcohol swab.

05

Administer the vaccine using the appropriate method (e.g. syringe, nasal spray).

06

Dispose of any used materials properly and wash hands thoroughly.

07

Keep documentation of vaccine administration for personal records and future reference.

Who needs 2022-2023 seasonal influenza flu?

01

Individuals who want to reduce their risk of contracting seasonal influenza.

02

People who are at high risk for complications from the flu, such as young children, elderly individuals, and individuals with certain health conditions.

03

Healthcare workers and other individuals who may come in contact with vulnerable populations.

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What is seasonal influenza flu vaccine?

Seasonal influenza flu vaccine is a vaccine that helps protect against the flu viruses that research indicates will be most common during the upcoming season.

Who is required to file seasonal influenza flu vaccine?

Healthcare providers and individuals who are at higher risk for complications from the flu are recommended to get the seasonal flu vaccine.

How to fill out seasonal influenza flu vaccine?

You can receive the seasonal influenza flu vaccine at a doctor's office, pharmacy, or other healthcare provider. They will administer the vaccine as an injection or nasal spray.

What is the purpose of seasonal influenza flu vaccine?

The purpose of the seasonal influenza flu vaccine is to help prevent illness from the flu virus and reduce its spread in the community.

What information must be reported on seasonal influenza flu vaccine?

Information reported on the seasonal influenza flu vaccine includes the type and dosage of the vaccine received, date of administration, and any adverse reactions experienced.

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