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File: /var/www/cuacinsects.org/htdocs/index.php
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Free Flu Vaccine Administration Record Template. What can you do to protect from the flu? Flu offline vaccination record form1.
Complete all requested information for each vaccine administered. Report your influenza immunization using the got my flu shot form on insite (ahs, apl, and recovery alberta) or compassionnet (covenant health). Immunization information system (iis) or “registry”:
Update the patient’s record with any new allergy, health condition or primary care provider information. ** please forward flu vaccine records to your member flu vaccination coordinator. 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.
Report your influenza immunization using the got my flu shot form on insite (ahs, apl, and recovery alberta) or compassionnet (covenant health). Record the generic abbreviation (e.g., tdap) or the trade name for each vaccine (see table at right). This vaccine is appropriate for this patient based on the responses to the screening questions and age guidelines according to acip.
Enter vaccine lot #, expiration date and site of administration, then scan the. Health care providers who administer vaccines covered by the national vaccine injury compensation program (vicp) are required under the national childhood vaccine. Information and screening question responses.
What can you do to protect from 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. Flu offline vaccination record form1.
Do not complete the form if you. A list of coordinators can be found under common documents on the flu. To record influenza, pneumococcal, zoster, hib, and other vaccines (e.g., travel vaccines).
