flu consent form 2020 gloucestershire

24 July 2020. 0000006783 00000 n 0000010872 00000 n It just means additional questions must be asked. We use strictly necessary cookies to make our site work. Information is also available from the following websites. 0000005461 00000 n endstream endobj 15 0 obj <>>>/Metadata 12 0 R/OpenAction 16 0 R/Outlines 7 0 R/PageLayout/SinglePage/Pages 11 0 R/Type/Catalog/ViewerPreferences<>>> endobj 16 0 obj <> endobj 17 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Tabs/W/Thumb 8 0 R/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>> endobj 18 0 obj <> endobj 19 0 obj <> endobj 20 0 obj [/ICCBased 40 0 R] endobj 21 0 obj <> endobj 22 0 obj <> endobj 23 0 obj <> endobj 24 0 obj <> endobj 25 0 obj <>stream Added the new flu season consent form … 14 0 obj <> endobj Have you ever had a reaction to a flu shot? Influenza/Pneumococcal Immunization Consent Form Influenza Consent I have read,or hadexplainedto me, the Vaccine Information Statement about influenza vaccination. 0000003282 00000 n You may also print this form and bring it in person to the pharmacy. Do you have cancer, leukemia, HIV/AIDS, or any other immune system problem? Health Protection Surveillance Centre website. If a question is not clear, please ask your healthcare provider. Any queries related to this consent form should be directed to the Office of the Nursing and Midwifery Services Director. 1 October 2020. Please click on the links below for Flu Medicine Protocols for the 2020/2021 season, Please click on the links below for the Flu Medicine Protocols training materials for the 2019/2020 season, The Online Seasonal Influenza Peer Vaccination Programme is now available from HSELand. <<03E323021DE3434096B435F182A064C5>]/Prev 40872>> For women: Are you pregnant or is there a chance you could become pregnant during the next month? 0000003058 00000 n 0000002332 00000 n (Optional) Select a time for your vaccination. I have hada chance to ask questions, which were answered to my satisfaction, and I understand the benefits and risks of the Any queries related to this position paper should be directed to the Workplace Health & Wellbeing Unit. 0000007584 00000 n 0000001447 00000 n Ask us a question, Units 8-9 Manor Street Business Park, Manor Street, Dublin 7, Flu vaccine for people with long-term conditions, Patient Information Leaflets and Vaccine Contents, Information about flu vaccine delivery for the 2020/2021 season, Eligiblity criteria for HSE influenza vaccination programme, LAIV queries about Down Syndrome and children living with someone who is immunosuppressed, Why flu vaccine is important for healthcare workers, flu vaccine for children aged 2 to 12 years, Clinic checklist for running an influenza clinic, Infection Prevention & Control precautions and PPE requirements when administering vaccines in the context of the Covid 19 pandemic, http://www.cdc.gov/vaccines/pubs/pinkbook/index.html#order, https://www.cdc.gov/flu/protect/keyfacts.htm, https://www.gov.uk/government/publications/influenza-the-green-book-chapter-19, Change to the NIAC Guidelines for treatment of Anaphylaxis, Online Seasonal Influenza Peer Vaccination Programme, Office of the Nursing and Midwifery Services Director. gelatin, eggs, latex, etc.). Employee Flu Shot Consent & Release Form ©2016 Health Advocate HA-BsM-1603076-3FOR-V2 Office Copy Please answer the following questions: (check Yes or No) Have you received a flu shot before? Quadrivalent Influenza Vaccine (split virion, inactivated), suspension for injection in prefilled syringe -, Fluenz Tetra nasal spray suspension Influenza vaccine (live attenuated, nasal) -. 0000001405 00000 n 0000003370 00000 n For patients between the ages of 2 and 4 years: has a healthcare provider told you that the child had wheezing or asthma in the past 12 months? The following Medicine Protocols and training materials were provided to the National Immunisation Office by the Office of the Nursing and Midwifery Services Director. The following position paper was provided to the National Immunisation Office by The Workplace Health & Wellbeing Unit. If you answer "yes" to any question, it does not necessarily mean you should not be vaccinated. Terms and conditions apply. Have you received any vaccinations or skin tests in the past 4 weeks? 2 You can also pay cash, flu shots start at $39.99 Flu shots for the whole family Every year we want to make sure flu prevention is your number- one priority. 0000010146 00000 n Get your flu shot. Early vaccination means you are better protected. The flu vaccine is a safe, effective way to help people stay healthy, prevent illness and save lives. Can't find what you're looking for? (Pneumonia, Shingles, TdaP, etc.). Have you, a sibling, or parent had a seizure or a brain or other nervous system problem? We are experiencing long delays at some locations, Please have your insurance card ready to upload. 0000011768 00000 n You will receive a merchandise coupon valid for 1-time use at CVS Pharmacy ® or Longs Drugs ® locations. Added revised consent form. During the past year, have you received a transfusion of blood or blood products, or been given immune (gamma) globulin or an antiviral drug?

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