Requesting such authorization may be recommended or necessary, depending on local needs and/or laws such as the Family Educational Rights and Privacy Act (FERPA) or the Health Insurance Portability and Accountability Act (HIPAA).

As long as all questions on the form are answered truthfully, and the patient is given sufficient explanation of the associated risks, the form may provide the practitioner with some protection from liability. A mechanism should also be provided for a parent/guardian who initially declines to give consent for his/her child to be vaccinated to subsequently change that election and give consent for the child to be vaccinated. For maximum protection, get a flu shot early in the season. Millions of Americans receive the flu vaccine each year, either by choice or because they are compelled to do so by their employer. Below are notes about each section on the template consent forms: Information about child to receive vaccine: This section includes suggestions for collecting personal and demographic information.
<>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Title: VNA-SLU Flu Shot Consent and Insurance Form 2020 NEW Author: Anne Marie Created Date: 10/8/2020 7:54:57 PM Instead, requirements for informed consent are legislated or regulated by each state or jurisdiction, including the circumstances under which minors can consent to their own medical treatment. Flu vaccine cannot prevent all cases of flu, but it is the best defence against the disease.
It should be signed by the patient, or, in the case of a minor, by a parent or legal guardian. These include soreness at the site of the shot, headache, fever, nausea, and muscle aches, according to the Centers for Disease Control (CDC). endobj To receive weekly email updates about Seasonal Flu, enter your email address: Centers for Disease Control and Prevention. In the U.S., children are vaccinated primarily in their pediatrician’s or family doctor’s office (Groom, 2007).

SLV program planners may also want to include a section for consent or authorization for disclosures of certain vaccination, medical, personal, and/or demographic information. e�(�hbR�qH�*W��;�����M4$�̠i*}��{������̝քڸ�.�6 �(�db՗p ����Qw���`�ȧ^��;Ý��%���;�3�L�ޡ���;��:������՘Hj+���>`�#E� �:p��ҏj��GgP��nRV���T*cl`/Iݟ����0�. © 2020 Electronic Forms LLC. <> Please also refer to the section below on “Legal issues” for important information on liability, licensing, FERPA, and HIPAA.

diabetes), neurologic or neuromuscular disease, anemia or other blood disorder?


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