Influenza Immunization Informed Consent - Employee - DIGITAL FORM
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UPDATED SEPTEMBER 2023
Briggs Influenza Immunization Informed Consent provides the employee with information regarding influenza and is used to document consent or declination of the influenza vaccine. It includes information regarding:
• | Hospitalization and deaths based on age |
• | Populations that are at high risk for complications from influenza |
• | Clinical influenza symptoms |
• | Possible vaccination side effects |
• | Important new information from CDC/ACIP that recommends the vaccine to individuals with egg-allergy |
The Vaccine Information Statement (VIS) section of this form allows providers to designate the type of vaccine administered as Quadrivalent for the current flu season. It also provides the web address to the FDA Fact Sheets for provision to the employee as part of the education for informed consent.
Send completed License Agreements toCustomerSupport@BriggsCorp.com
*This digital form is delivered as a form-fillable PDF and includes 1-year of updates. To receive your electronic file and updates you must complete and return a content license agreement and provide an end-user email address and contact name for file delivery (please allow 2-3 business days for order fulfillment). After 1- year, your update subscription will automatically renew.
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*This digital form is delivered as a form-fillable PDF and includes 1-year of updates. To receive your electronic file and updates you must complete and return a content license agreement and provide an end-user email address and contact name for file delivery (please allow 2-3 business days for order fulfillment). After 1- year, your update subscription will automatically renew.