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2009 H1N1 Influenza Vaccine Consent Form for Use With Either Intramuscular, Injectable Formulation or Live Attenuated, Intranasal Formulation of Vaccine Author Centers for Disease Control and Prevention (CDC)
6 Νοε 2024 · A flu shot (influenza) vaccine consent form is a written authorization that gives a nurse or other medical practitioner the go-ahead to administer the flu vaccine. It should be signed by the patient, or, in the case of a minor, by a parent or legal guardian.
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 FOR VACCINATION – I verify that I have read the current CDC Vaccination Information Statement and consent to receive the influenza vaccination.
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?
Section 2: Consent. CONSENT FOR CHILD’S VACCINATION: I have read or had explained to me the Vaccine Information Statement for the influenza vaccine and understand the risks and benefits. I GIVE CONSENT. for my child named at the top of this form to get vaccinated with this vaccine.
