Cool Flu Vaccine Administration Record Template. See page 2 to record influenza, hib, zoster, and other vaccines (e.g., travel vaccines). Health care providers who administer vaccines covered by the national vaccine injury compensation program (vicp) are required under the national childhood vaccine.
Immunization information system (iis) or “registry”: A list of coordinators can be found under common documents on the flu. Please contact us if you have.
Information and screening question responses. Do not complete the form if you. To record influenza, pneumococcal, zoster, hib, 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). Record the generic abbreviation (e.g., tdap) or the trade name for each vaccine (see table at right). ** please forward flu vaccine records to your member flu vaccination coordinator.
Record the date of vaccination and the name/location of the administering clinic. 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. See page 2 to record influenza, hib, zoster, and other vaccines (e.g., travel vaccines).
Health care providers who administer vaccines covered by the national vaccine injury compensation program (vicp) are required under the national childhood vaccine. Flu offline vaccination record form1. 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.
Enter vaccine lot #, expiration date and site of administration, then scan the. What can you do to protect from the flu? Please contact us if you have.
