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  1. 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.

  2. 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.

  3. Using an immunization information system to document vaccines administered can help to keep patient vaccination records up to date and give all medical providers that care for a patient access to complete and accurate information about the patient’s immunization history.

  4. 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 .

  5. 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.

  6. 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.

  7. 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?