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List Of Flu Vaccine Administration Record Template. Do not complete the form if you. Enter vaccine lot #, expiration date and site of administration, then scan the.
Flu offline vaccination record form1. Information and screening question responses. Complete all requested information for each vaccine administered.
Do not complete the form if you. Report your influenza immunization using the got my flu shot form on insite (ahs, apl, and recovery alberta) or compassionnet (covenant health). 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. 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.
A list of coordinators can be found under common documents on the flu. What can you do to protect from the flu? Record the generic abbreviation (e.g., tdap) or the trade name for each vaccine (see table at right).
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. Please contact us if you have. Update demographic information and complete at each vaccine administration.
Immunization information system (iis) or “registry”: This vaccine is appropriate for this patient based on the responses to the screening questions and age guidelines according to acip. (pdf 1.52 mb) (english and spanish) (updated october 2018) vaccine ordering, storage and handling.
