October 15, 2020 by Daniel Weiss. National Flu Vaccination Record Form 2020/21 (Word), National Flu Vaccination Record Form 2020/21 (PDF). Scroll down to “Hofstra Forms” 6. If yes to any questions 1-3 then DO NOT vaccinate with influenza vaccine. The eligible patient groups in 2020/21 have changed, so it is therefore important to discard any previously printed versions of the Flu Vaccination record forms from previous years and ensure that the new form is used. h��Ymo�6�+��aȎ��7`(���-��Y��[�|Pl��fK��d�~�b�or�aPdR��E�=�ݣ(�DB   This page contains information on the patient consent requirements and the record keeping requirements for the flu vaccination service. h�bbd``b`��@,- �>H�� � You can find this on any pricing authority statement or your prescription submission document (FP34c). Where IT support is not available, contractors will instead be able to use a paper-based record keeping system. Influenza Immunization. Once completed, it should be sent to the medical professional providing the flu shot. %%EOF The flu shot consent form must be completed before a influenza vaccine is administered.The document ensures that the receiver of the vaccination is aware of the process and side effects, and that they’ve had ample opportunity to field any questions they may have. In the top-right corner, click the 3x3 grid, also known as “My Apps” 3. Join our mailing list for a weekly round-up of news and resources, plus price concession/NCSO alerts. The way to complete the Online how to create the flu vaccine consent form for employee on the internet: To start the form, utilize the Fill & Sign Online button or tick the preview image of the document. Influenza (Seasonal Flu) Shot Patient Consent Form. How To Consent to a Flu Vaccine 1. Report product over Drug Tariff price �cQ��I�'�fn��. x���sܶ���bY>�r4 ��G�W��v�i?T���8M2r������o�'�N'מёK�}� �=S����Su���Mm��L.��5vPn��w^W/^���j��M���|�M������v�Ӫ���-�����K���A����Ou�.��_�޺���m��u,m���f{�K�.ϕ��Z�*�F��3�������9�}�V�~�L/��˓�'_�����V�#ܪ�#�a/Ϋ����L���q|ܛ=��.�Q{���|Ѓ�u�N|��u`t���h��(݊T�P����W���A�v]�ںE��:�e\���~�X����Н��Mk�m��,sA� 1347 0 obj <>/Filter/FlateDecode/ID[<339B2957A38E4526ACE76DDF17B1D8EC><2672A5A15922F94A84553059F195A39B>]/Index[1320 50]/Info 1319 0 R/Length 119/Prev 87975/Root 1321 0 R/Size 1370/Type/XRef/W[1 2 1]>>stream be given to me (or the person named above for whom I am authorized to make this request).and I understand the benefits and risks of influenza vaccination. Find out what’s happening in the wider NHS. The General Pharmaceutical Council’s Guidance on Consent provides information on consent for pharmacists and their teams. Step 3 – The following questions must be answered before a flu shot can be given. The document ensures that the receiver of the vaccination is aware of the process and side effects, and that they’ve had ample opportunity to field any questions they may have. How to find us Flu Shot Consent Form – Influenza Vaccine, Boy Scouts of America (BSA) Activity Consent Form, Body Piercing Consent Form – For Adults and Minors, Tattoo Consent Form – For Adults and Minors, Authorization Forms – Adobe PDF and Microsoft Word, Prior Prescription (RX) Authorization Forms. Parents/guardians may seek the advice of others, including their child’s health care provider (Woodruff, 1996). �� �������eݸ졫F��Ī� Z�݀7j~�4������B#�A ]�S�l�ƂE5a���|�� 3q,N��juu~z�N���e� 汩ϫ v��lFx�x��a.B��ͩ�f�ޤG��U{q8M!��C�{'�$e� |�Ԃ���9����^i\�݅��U��2��.-��O��Q�ήVMP*{^�4���}x�8|/V�{��[��n' l��ۮ15��sa���=��h#>:Cs�ꨒ2Cn��IaK��??�? 14 Hosier Lane The patient should also be informed that information relating to their vaccination may be shared with NHS England and the NHS Business Services Authority (NHSBSA) as part of post-payment verification (PPV). Influenza Vaccine Consent Form 2018. Log onto your portal at my.hofstra.edu 2. Because the idea of vaccinating children at school may be unfamiliar to some parents/guardians, there may be reluctance to consent to influenza vaccination at school. Patient consent can be obtained verbally and should be recorded in the pharmacy’s clinical record for the service. �=�3���t�黠���֠��UF�*i�J�| Enter your official identification and contact details. For this reason, the success of SLV programs also will be enhanced by enlisti… 1369 0 obj <>stream Our monthly updates on dispensing news and guidance, plus a variety of factsheets. 1320 0 obj <> endobj It should be signed by the patient, or, in the case of a minor, by a parent or legal guardian. Select “Yes” or “No” beside each before continuing. This portal provides links to websites for all Local Pharmaceutical Committees (LPCs). 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 'http':'https';if(!d.getElementById(id)){js=d.createElement(s);js.id=id;js.src=p+'://platform.twitter.com/widgets.js';fjs.parentNode.insertBefore(js,fjs);}}(document, 'script', 'twitter-wjs'); Website feedback form %��������� Annual Influenza Vaccine Consent Form-FLU SHOT and NASAL SPRAY; Below are notes about each section on the template consent forms: Section 1.