Get the free Pneumococcal Polysaccharide addendum - Texas Department of ... - dshs texas

Texas Department of State Health Services Addendum to Pneumococcal Polysaccharide Vaccine (PSV) Vaccine Information Statement 1. I agree that the person named below will get the vaccine checked below.

How to fill out pneumococcal polysaccharide addendum

How to fill out pneumococcal polysaccharide addendum:

1. Obtain the pneumococcal polysaccharide addendum form from a healthcare provider or government agency. This form is typically required for individuals who need to provide proof of vaccination.
2. Ensure that you have received the pneumococcal polysaccharide vaccine prior to filling out the addendum form. The vaccine is recommended for certain high-risk individuals, such as elderly adults or those with certain medical conditions.
3. Begin by filling out your personal information on the addendum form. This includes your full name, date of birth, address, and contact information. Make sure to provide accurate and up-to-date details.
4. Indicate the date on which you received the pneumococcal polysaccharide vaccine. This information is crucial as it helps establish the validity and effectiveness of the vaccination.
5. Specify the healthcare provider or clinic where you received the vaccine. This may require you to provide their name, address, and contact information. If available, include any relevant documentation or proof of vaccination provided by the healthcare provider.
6. Review the form for accuracy and completeness. Ensure that all sections are filled out correctly and legibly. If you have any questions or concerns, consider reaching out to your healthcare provider for guidance.

Who needs pneumococcal polysaccharide addendum:

1. Individuals who have received the pneumococcal polysaccharide vaccine and require documentation of their vaccination status may need a pneumococcal polysaccharide addendum.
2. This may be necessary for individuals who work in certain industries or professions that require proof of vaccination, such as healthcare workers, educators, or individuals seeking employment in high-risk environments.
3. Additionally, individuals who are planning to travel to certain countries or participate in activities that have a higher risk of pneumococcal infection may also need a pneumococcal polysaccharide addendum.

Note: It is essential to consult with a healthcare provider or relevant authority to determine if a pneumococcal polysaccharide addendum is required in your specific situation.

For pdfFiller’s FAQs

What is pneumococcal polysaccharide addendum?

It is a form used to report information about pneumococcal polysaccharide vaccine administration.

Who is required to file pneumococcal polysaccharide addendum?

Healthcare providers who administer pneumococcal polysaccharide vaccines are required to file the addendum.

How to fill out pneumococcal polysaccharide addendum?

The addendum should be filled out with information about the vaccine administration, including patient details and vaccine lot number.

What is the purpose of pneumococcal polysaccharide addendum?

The purpose is to track and report vaccine administration data to relevant authorities for monitoring and public health purposes.

What information must be reported on pneumococcal polysaccharide addendum?

Information such as patient name, date of birth, vaccination date, vaccine manufacturer, lot number, and healthcare provider details.

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