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School Consent for 2009 H1N1 Influenza Injectable Vaccine Section 1: Information about Child to Receive Vaccine (PLEASE PRINT CLEARLY) STUDENT S NAME (Last) (First) (M.I.) PARENT/LEGAL GUARDIAN S
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How to fill out the h1n1-injectable-consent-form - dda:

01
Start by reading the entire form carefully and familiarize yourself with its contents.
02
Provide your personal information accurately in the designated fields. This may include your name, address, phone number, and date of birth.
03
Indicate your medical history and any relevant allergies or medical conditions that the healthcare provider should be aware of.
04
Confirm your consent for receiving the H1N1 injectable vaccine by signing and dating the form.
05
If applicable, provide the name and contact information of your parent or legal guardian if you are a minor.

Who needs the h1n1-injectable-consent-form - dda:

01
Individuals who are planning to receive the H1N1 injectable vaccine may need to fill out this consent form. This may include people of all ages, including minors.
02
The form is necessary to ensure that the individual is fully informed about the risks, benefits, and potential side effects of the H1N1 vaccine.
03
The form also helps healthcare providers document the individual's consent and gather necessary medical information to ensure safe administration of the vaccine.
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