Professional Flu Vaccine Administration Record Template

Record The Date Of Vaccination And The Name/Location Of The Administering Clinic.

Information and screening question responses. Update the patient’s record with any new allergy, health condition or primary care provider information. Flu vaccine administration record if you are receiving your flu vaccine from an outside provider, please ask them to document all required information listed below.

Before Administering Any Vaccines, Give The Patient Copies Of All Pertinent Vaccine Information Statements (Viss) And Make Sure He/She Understands The Risks And Benefits Of The Vaccine(S).

Report your influenza immunization using the got my flu shot form on insite (ahs, apl, and recovery alberta) or compassionnet (covenant health). We want to make certain that you have information about the vaccines or antibody product we administered so you can update your patient’s medical record. See page 2 to record influenza, hib, zoster, and other vaccines (e.g., travel vaccines).

What Can You Do To Protect From The Flu?

This vaccine is appropriate for this patient based on the responses to the screening questions and age guidelines according to acip. Understand the benefits and risks of the vaccine and request that the vaccine indicated on this form be given to me or the person named on this health record for who i am authorized to. To record influenza, pneumococcal, zoster, hib, and other vaccines (e.g., travel vaccines).

Record The Generic Abbreviation (E.g., Tdap) Or The Trade Name For Each Vaccine (See Table At Right).

Flu offline vaccination record form1. ⧠ continue with vaccine administration ⧠ vaccination not given (see. Immunization information system (iis) or “registry”:

** Please Forward Flu Vaccine Records To Your Member Flu Vaccination Coordinator.

(pdf 1.52 mb) (english and spanish) (updated october 2018) vaccine ordering, storage and handling. A list of coordinators can be found under common documents on the flu. Health care providers who administer vaccines covered by the national vaccine injury compensation program (vicp) are required under the national childhood vaccine.