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ADULT FLU AND PNEUMONIA VACCINE CONSENT 20152016 WHITE **PLEASE PRINT** Please have photo identification and all health insurance cards ready to present for review. We will be happy to assist in completing
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How to fill out flu or pneumonia vaccine

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How to fill out flu or pneumonia vaccine:

01
Consult with a healthcare professional: Before filling out the flu or pneumonia vaccines, it is important to consult with a healthcare professional. They will provide guidance on which vaccine is needed and whether any specific precautions should be taken.
02
Determine the type of vaccine: Flu and pneumonia vaccines come in different types, such as injections or nasal sprays. The healthcare professional will advise on the most appropriate type based on age, health condition, and medical history.
03
Fill out necessary forms: When receiving the vaccine, there might be some forms or consent documents that need to be completed. These forms typically ask for personal information, medical history, and any allergies. It is important to fill out these forms accurately and truthfully.
04
Provide insurance information: If applicable, provide your insurance information to the healthcare professional. Insurance coverage may help with the cost of the vaccine.
05
Choose the vaccine provider: Depending on the country, flu or pneumonia vaccines may be available at various locations such as clinics, pharmacies, or healthcare facilities. Choose a reputable and reliable provider to ensure the quality and effectiveness of the vaccine.

Who needs flu or pneumonia vaccine:

01
High-risk individuals: Certain individuals are at a higher risk of developing complications from the flu or pneumonia, such as older adults (65 years and older), young children, pregnant women, and individuals with chronic medical conditions like asthma, diabetes, or heart disease. These individuals are strongly encouraged to get the flu or pneumonia vaccine.
02
Healthcare workers: Healthcare workers are often exposed to patients who may have flu or pneumonia. Getting vaccinated is essential to protect both themselves and their patients from contracting and spreading the diseases.
03
Caregivers and close contacts: Individuals who come into close contact with high-risk individuals, such as caregivers of young children or those living with elderly or immunocompromised individuals, should also get vaccinated to lower the risk of transmitting the flu or pneumonia to vulnerable individuals.
04
Travelers: People who frequently travel, especially to regions where flu or pneumonia outbreaks are common, should consider getting vaccinated to protect themselves from these diseases while away from home.
05
General population: While it is recommended for high-risk individuals and certain groups, anyone can benefit from getting the flu or pneumonia vaccine. It helps to reduce the spread of these diseases and protect the overall population, especially during flu seasons or when outbreaks occur.
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Flu or pneumonia vaccine is a type of immunization that helps protect against influenza or pneumonia infections.
Individuals who are at high risk of contracting influenza or pneumonia are required to get the flu or pneumonia vaccine.
You can get the flu or pneumonia vaccine by visiting a healthcare provider or a vaccination clinic.
The purpose of the flu or pneumonia vaccine is to reduce the risk of getting infected with influenza or pneumonia viruses.
The information reported on the flu or pneumonia vaccine typically includes the date of vaccination, the type of vaccine administered, and the individual's medical history.
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