WebVACCINE DOCUMENTATION/CONSENT FORM I have been offered a copy of the Vaccine Information Statement(s) (VIS) checked below. I have read, had explained to me, and understand ... Influenza LAIV4 IIV3 IIV4 0.1mL 0.2mL 0.25mL 0.50mL 1 2 RT LT Upper Arm Deltoid Vastus Lat Intradermal Intranasal IM MCV4 0.5 mL 1 2 RT LT Deltoid IM WebPeople who are not at high risk for severe influenza complications and who are known to have developed Guillain-Barré syndrome (GBS) within 6 weeks after receiving a previous …
Vaccine Information Statements - VISs - CDC information sheets …
WebI consent to receiving the seasonal influenza vaccine. If signing for someone other than yourself, indicate your relationship to that other person: _____ If signing for someone other than myself, I confirm that I am the parent / legal guardian or substitute decision maker. Signature: _____ Print: _____ ... WebDec 5, 2024 · Vaccine Information Statements (VISs) are information sheets produced by the Centers for Disease Control and Prevention (CDC). VISs explain both the benefits and risks of a vaccine to adult vaccine recipients and the parents or legal representatives of. vaccinees who are children and adolescents. Federal law requires that VISs be handed … cucirca american horror story
Commonly Used Patient Forms in Spanish Cigna
WebDec 19, 2024 · When you provide patients with an out-of-date translation of a VIS, CDC states you should also provide the corresponding up-to-date English-language version of the VIS. You Must Provide Patients with … WebPATIENT CONSENT FORM FOR SEASONAL INFLUENZA VACCINE I have read, or have had explained to me, the CDC Vaccine Information Statement about influenza and the … WebGetting a Flu Vaccine during the COVID-19 Pandemic. Similarities and Differences between Flu and COVID-19. For more information about COVID-19, see the COVID-19 section of our website. The flu spreads easily, and there are lots of ways to catch it. The flu is especially hard on older adults and small children, so keep your family protected. easter bunny nose clipart