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Influenza Immunization Informed Consent - Employee

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SKU: 7123S

This form provides employees information regarding influenza and is used to document consent or declination of the influenza vaccine. It includes information regarding

Ÿ     Which populations are at a high risk for complications from influenza
Ÿ     Clinical Influenza symptoms
Ÿ     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. 

Download a sample today!

Color: White paper with black ink

Size: 8-1/2" x 11"

Hole Punch: 5 holes on top and side

Printed: 1 side

Quantity: 100 ea/pd 

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