Influenza Immunization Informed Consent - Employee
This form provides employees information regarding influenza and is used to document consent or declination of the influenza vaccine. It includes information regarding
Which populations are at a high risk for complications from influenza
Clinical Influenza symptoms
Possible vaccination side effects
The Vaccine Information Statement (VIS) as allows providers to designate the type of vaccine administered: standard trivalent, high dose trivalent or quadrivalent.