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flu vaccine consent form 2019 pdf

209 0 obj <> endobj 226 0 obj <>/Filter/FlateDecode/ID[<08080550285B4E3595DBBC06D3FAC955>]/Index[209 37]/Info 208 0 R/Length 97/Prev 743068/Root 210 0 R/Size 246/Type/XRef/W[1 3 1]>>stream The flu vaccine is very safe and generally people have no reaction. %PDF-1.5 %���� I understand the risks and benefits associated with the influenza vaccine and have had any questions satisfactorily answered. Annual Influenza Vaccine Consent Form-FLU SHOT and NASAL SPRAY; Below are notes about each section on the template consent forms: Section 1. These symptoms clear up within a few days. I hereby acknowledge that, based on the information presented to me, I am eligible to receive the influenza vaccine on this date.

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��NH'Q^�V�!�RT��;�� ���3� Wx�n\^����Ѐ� ��� wH�8��,�=`o1�X��i�����+� �J� Sign In. Information about child to receive vaccine: This section includes suggestions for collecting personal and demographic information. {����K��e�%�7. 0 I understand that in the course of the requested vaccine administration, an H-E-B Pharmacy representative could possibly be exposed to my blood or bodily fluids. 09162020 Health Operations/Forms Flu Vaccine Consent Form – 2020/2021 Date of Birth (Month/Date/Year): Age: Sex: ___M ___F Last Name: First Name: h�b``�```:� +/3�F fa�h@ӀbS~��2r&i^9�tp��> ��{� ��P%����6� �T�f1`:�v�����D�i����d%�1�4�A�sm5�fb`�������p�$D�� � �r �

Consent I am providing this consent form to OccuVAX in order that I may be given the influenza vaccination. %PDF-1.6 %���� care provider. 2018-2019 Student Seasonal Influenza Vaccine Consent Form.pdf. I have read and understand the information I have received concerning the possible benefits and side effects of the influenza vaccination. 2018-2019 Student Seasonal Influenza Vaccine Consent Form.pdf. h�bbd```b``: "��"��L��H�f0;̖�k��I����$s7�MP�̫@"{��v%�D��4$�30*} ��� ��K endstream endobj startxref 0 %%EOF 244 0 obj <>stream hޔ�1AA��{����Q�D�� �Z�TY� ��B���/(U*�H���'� ͗393g­na�6�� h�Ė�n�8�_��-Ϥ|�[Mv{��.��uؒ!����;C,�v�]`[2��9$�_��0"D@��"$& BBK ���2� ��PJ�Y��"\Z��p��Ҁ��%�q�FkM�‰�(�� �phV M޽��kz��dG��G�����*�}H��x�&��p����e BN'߶w�z$�q:K\�}�� %����BpC�d[)�"Ϫ�4�.4�������w�${G��ޕ7��|�d��׾�\1F�U�K&�v��]�I�-Q�^'OuB�`EW����z8fU��*/��&Y���e�d�H8|��^��6 �����B�v4��Z!�1ֿ��hm��o;�Aص��Qhao=Vxշ�O�ΈV���ٵ�=�*��E�>�Ʈ���8��LJ�'y���!G�]�M�2�ꋴ(��cR�1�d�~Ln �.8]}���u��y�:��Ǭ�r�����/k.� �"��b��6Cu�q�IZu�����SJ9���5�1�>�&Zֽ>�f�P�2oa�=������ئ�ze?o�xzE4e���z�2�vhk��@.���S�kl���� ����7��Q���?��+`�7� �V�o�ۦeUvn�����E�s�/%�_�oǜE�U,��Dx��D�� �!z��D#�����Pk�����jlX]ԩ� tl���q���ͭ��! The most common side effects are tenderness, swelling and redness at the injection site which usually disappears within a few days. endstream endobj startxref 173 0 obj <> endobj

Section 2.

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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) Subject: H1N1 flu vaccination Created Date: 10/31/2019 8:33:11 AM "The Flu Vaccine - Protect yourself, Protect others" This module has been developed by the Workplace Health and Wellbeing Unit ... Anaphylaxis Protocol (Updated April 2019) Self Assessment; Please click on the links below for the Flu Medicine Protocols training materials for the 2019/2020 season. Flu Vaccine Form Patient Name: Date: F: M: DOB: Age: Phone: Address: City: State: Zip: I, the undersigned, have read or had explained to me the vaccine information sheet (VIS). In such event, I agree to review and execute the “H-E-B Post-exposure Consent for Testing” form. A small percentage of people may experience a mild fever and feel unwell for a few days – this is not the flu.

Title: Microsoft Word - FLU VACCINE CONSENT FORM 2018-2019 Author: bob.saturn Created Date: 8/10/2018 4:24:54 PM

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