• Home
  • Influenza Immunization Informed Consent

Influenza Immunization Informed Consent

(0) No Reviews yet
$22.85
SKU: 7123
$22.85

This form provides patient/resident 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 

Ratings & Reviews

No reviews available

Be the first to Write a Review