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KanawhaCharleston Health Department 108 Lee Street, East Charleston WV 25301 Seasonal Influenza/Pneumococcal Vaccination Consent/Administration Form Name _________(Last)(First)(Middle Initial)Mailing
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How to fill out seasonal influenzapneumococcal vaccination

How to fill out seasonal influenzapneumococcal vaccination
01
Make an appointment with your healthcare provider or visit a flu clinic offering the vaccination.
02
Bring any necessary identification and insurance information.
03
Inform the healthcare provider of any allergies or previous adverse reactions to vaccines.
04
Receive the seasonal influenza vaccine, which is most commonly given as an injection in the arm.
05
Receive the pneumococcal vaccine if recommended by your healthcare provider.
Who needs seasonal influenzapneumococcal vaccination?
01
Individuals over the age of 65, as they are at higher risk for serious complications from influenza and pneumonia.
02
Individuals with certain chronic medical conditions, such as heart disease, lung disease, diabetes, and weakened immune systems.
03
Pregnant women, as they are at increased risk for complications from influenza.
04
Healthcare workers, caregivers, and household contacts of high-risk individuals to prevent transmission of the viruses.
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What is seasonal influenza pneumonia vaccination?
Seasonal influenza pneumonia vaccination is a vaccination that helps protect individuals against seasonal influenza and pneumococcal disease.
Who is required to file seasonal influenza pneumonia vaccination?
Certain individuals, such as healthcare workers, elderly individuals, and individuals with certain medical conditions, may be required to receive seasonal influenza pneumonia vaccination.
How to fill out seasonal influenza pneumonia vaccination?
To fill out seasonal influenza pneumonia vaccination, individuals can visit a healthcare provider or vaccination clinic to receive the required vaccines.
What is the purpose of seasonal influenza pneumonia vaccination?
The purpose of seasonal influenza pneumonia vaccination is to reduce the risk of illness, hospitalization, and death related to influenza and pneumococcal disease.
What information must be reported on seasonal influenza pneumonia vaccination?
Information such as the date of vaccination, the type of vaccine received, and the person receiving the vaccine may need to be reported on the seasonal influenza pneumonia vaccination record.
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