Printable Flu Shot Form

Is The Person To Be Vaccinated Sick Today Or Had A Fever Of Greater Than 100.4°F In The Last 24 Hrs?

The influenza virus can mutate from year to. I hereby consent to the administration of the flu vaccine for which i have signed below be given to me or the person named above for whom i am authorized pursuant to sections 431.058,. Understand the risks and benefits associated with the influenza vaccine and have had any questions satisfactorily answered. Have you taken an antiviral medication for the flu within the last 48 hours?

Vaccine Consent Form Section 1:

I have read, or had explained to me, the vaccine information statement about influenza vaccination. Have you ever fainted or felt dizzy after receiving an. Consent form for seasonal influenza (flu) vaccine i have read or have had explained to me the information about influenza and influenza vaccine. (if so, you should wait until you have recovered before receiving a flu.

It Is Our Policy That You Wait 15 Minutes After The Administration Of The Vaccine, Due To The Possibility Of An.

I voluntarily request that the vaccine be given to me or for the If you answer “yes” to one or more of the following four questions, your child may be able to get the seasonal influenza vaccine, but we will contact you to discuss your options. Do you currently have a high fever? Does the person to be.

Influenza Vaccine, Before July 1, 2023, (The Two Doses Need Not Have Been Received During The Same Season Or Consecutive Seasons) Should Receive A Second Dose Of Influenza Vaccine At.

If you answered yes to any of the above, you may not receive a flu shot this year. Have you received any vaccinations in the last 6 weeks? Please read the vaccination information sheet and answer the following questions. Consent form for seasonal influenza (flu) vaccine.