Influenza Immunization Informed Consent
UPDATED SEPTEMBER 2023
Briggs Influenza Immunization Informed Consent provides patient/resident 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 patient/resident/representative as part of the education for informed consent.
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