Incredible Flu Vaccine Administration Record Template

Health Care Providers Who Administer Vaccines Covered By The National Vaccine Injury Compensation Program (Vicp) Are Required Under The National Childhood Vaccine.

Complete all requested information for each vaccine administered. Enter vaccine lot #, expiration date and site of administration, then scan the. Flu vaccine administration record if you are receiving your flu vaccine from an outside provider, please ask them to document all required information listed below.

Update The Patient’s Record With Any New Allergy, Health Condition Or Primary Care Provider Information.

(pdf 1.52 mb) (english and spanish) (updated october 2018) vaccine ordering, storage and handling. Information and screening question responses. Report your influenza immunization using the got my flu shot form on insite (ahs, apl, and recovery alberta) or compassionnet (covenant health).

Please Contact Us If You Have.

See page 2 to record influenza, hib, zoster, and other vaccines (e.g., travel vaccines). Before administering any vaccines, give the patient copies of all pertinent vaccine information statements (viss) and make sure he/she understands the risks and benefits of the vaccine(s). A list of coordinators can be found under common documents on the flu.

Understand The Benefits And Risks Of The Vaccine And Request That The Vaccine Indicated On This Form Be Given To Me Or The Person Named On This Health Record For Who I Am Authorized To.

Immunization information system (iis) or “registry”: ⧠ continue with vaccine administration ⧠ vaccination not given (see. We want to make certain that you have information about the vaccines or antibody product we administered so you can update your patient’s medical record.

To Record Influenza, Pneumococcal, Zoster, Hib, And Other Vaccines (E.g., Travel Vaccines).

Record the date of vaccination and the name/location of the administering clinic. What can you do to protect from the flu? Do not complete the form if you.