Get the free Dialysis Patient Influenza Vaccination form - cdc

Form Approved OMB No. 09200666 Exp. Date: 12/31/2017 www.cdc.gov/nhsn Page 1 of 1 Dialysis Patient Influenza Vaccination * required for saving conditionally required *Event #: *Facility ID: *Patient

How to fill out dialysis patient influenza vaccination

How to fill out dialysis patient influenza vaccination:

1. Obtain the necessary forms: Contact the healthcare provider or the dialysis center to request the influenza vaccination form for dialysis patients. This form will typically require information such as the patient's name, date of birth, medical history, and any known allergies.
2. Verify eligibility: Before filling out the form, ensure that the patient meets the criteria for receiving the influenza vaccination. Dialysis patients, especially those with weakened immune systems, are considered high-risk groups and are typically recommended to receive the annual flu shot.
3. Provide patient information: Fill out the form with accurate and up-to-date information about the dialysis patient. This includes the patient's full name, address, contact number, and date of birth.
4. Medical history: Record the patient's medical history on the form. Include information about any current or past medical conditions, medications being taken, allergies, and recent hospitalizations or surgeries. This information helps healthcare providers assess the patient's eligibility and any potential contraindications for the flu vaccine.
5. Influenza vaccine consent: Indicate the patient's consent to receive the influenza vaccination by signing the designated section on the form. Ensure that the patient or their legal guardian fully understands the benefits and risks associated with the vaccine.
6. Communicate with healthcare provider: Once the form is completed, reach out to the healthcare provider or the dialysis center to schedule the influenza vaccination appointment for the dialysis patient. This will ensure that the patient receives the appropriate dose and timing of the vaccine.

Who needs dialysis patient influenza vaccination:

1. Dialysis patients: Individuals receiving dialysis treatment for kidney failure are at a higher risk of encountering complications from influenza. Their weakened immune systems make them more susceptible to respiratory infections and severe illness.
2. Elderly dialysis patients: Older adults above the age of 65 who are on dialysis are particularly vulnerable to influenza-related complications. Vaccination helps protect them from developing severe symptoms and reduces the risk of hospitalization or mortality.
3. Dialysis center staff and caregivers: Those who work in dialysis centers or provide care to dialysis patients should also consider receiving the influenza vaccination. This helps prevent the spread of the virus to vulnerable dialysis patients and reduces the risk of infection within the healthcare setting.

For pdfFiller’s FAQs

What is dialysis patient influenza vaccination?

Dialysis patient influenza vaccination is a process where patients undergoing dialysis receive the flu vaccine to help protect them from influenza.

Who is required to file dialysis patient influenza vaccination?

Healthcare providers or facilities that provide dialysis treatment are required to file dialysis patient influenza vaccination records.

How to fill out dialysis patient influenza vaccination?

To fill out dialysis patient influenza vaccination, healthcare providers or facilities should document the administration of the flu vaccine to dialysis patients and submit the necessary forms to the relevant authorities.

What is the purpose of dialysis patient influenza vaccination?

The purpose of dialysis patient influenza vaccination is to reduce the risk of dialysis patients contracting the flu, which could lead to serious complications or hospitalizations.

What information must be reported on dialysis patient influenza vaccination?

The information that must be reported on dialysis patient influenza vaccination includes the patient's name, date of birth, date of vaccination, type of vaccine administered, and the name of the healthcare provider or facility administering the vaccine.

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