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H1N1 INFLUENZA VACCINE (SHOT) CONSENT/DECLINATION FORM. The H1N1 influenza vaccine is offered free of charge as a benefit to all employees, volunteers and students who qualify for vaccination based on CDC/APIC recommendations about who should get vaccinated this flu season.
Consent Form. Section 1: Information for Individuals receiving the 2019-20 Quadrivalent Influenza Vaccine (please print) Section 2: Vaccine Eligibility . Section 3: Consent. CONSENT FOR VACCINATION: . have been given a copy and have read, or have had explained to me, information about the disease and the vaccine to be received.
14 Μαρ 2024 · Trivalent flu vaccines are formulated to protect against three main groups of circulating seasonal influenza Type A and B viruses, an A (HIN1) virus, an A (H3N2) virus, and a B/Victoria lineage virus. Keep Reading: Trivalent Influenza Vaccines. Projected U.S. Flu Vaccine Supply for the 2024-2025 Season.
This document is intended to inform you of the upcoming vaccination campaign and ask for your signed consent. After reading the following information , please fill out the vaccination consent form and return it to school. Thank you very much for your cooperation and support.
INFLUENZA VACCINE CONSENT FORM. Patient’s Name: Date of Birth: MRN#. 1. Have you ever had an allergic reaction to flu vaccine? 2. Are you allergic to eggs, or egg product?
This Pandemic Influenza Pediatric Office Plan Template is a planning tool developed by pediatric stakeholders that is intended to assist pediatric medical offices that have no pandemic influenza plan in place, but may experience an increase in patient calls/visits or workload due to pandemic influenza .
CONSENT FOR VACCINATION – I verify that I have read the current CDC Vaccination Information Statement and consent to receive the influenza vaccination.
