Vaccine Information Statement 2012-2025 free printable template
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Medicare # Other 3rd Party ID# Cash Screening Questionnaire, Consent and Physician Fax Form Patient Information: (Patient to complete*) *Patient Name: *Date of Birth: *Phone# *Address: *City: *State:
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How to fill out flu vaccine consent form for adults
How to fill out Vaccine Information Statement
01
Obtain the Vaccine Information Statement (VIS) for the specific vaccine from the CDC website.
02
Ensure you have the correct version of the VIS that corresponds to the vaccine being administered.
03
Print or download the VIS for distribution to the patient or guardian.
04
Before administering the vaccine, review the key information in the VIS with the patient or guardian.
05
Provide a copy of the VIS to the patient or guardian for their records.
06
Document in the patient's record that the VIS was provided and reviewed.
Who needs Vaccine Information Statement?
01
Anyone receiving a vaccine for the first time.
02
Parents or guardians of children receiving vaccines.
03
Healthcare providers administering vaccines.
04
Individuals seeking information about vaccine risks and benefits.
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What is Vaccine Information Statement?
The Vaccine Information Statement (VIS) is a document created by the Centers for Disease Control and Prevention (CDC) that provides information about vaccines, including their benefits and risks. It is designed to help patients and caregivers make informed decisions about vaccination.
Who is required to file Vaccine Information Statement?
Healthcare providers who administer vaccines are required to provide the Vaccine Information Statement to patients or their guardians before the vaccine is given.
How to fill out Vaccine Information Statement?
Filling out a Vaccine Information Statement typically involves providing information about the vaccine being administered, including the date of administration, the name of the vaccine, and any relevant patient information. It is important to ensure that the VIS is given to the patient and that they understand its contents.
What is the purpose of Vaccine Information Statement?
The purpose of the Vaccine Information Statement is to educate patients and caregivers about the vaccine they are receiving, including the potential side effects and the importance of vaccination, thereby promoting informed consent.
What information must be reported on Vaccine Information Statement?
The Vaccine Information Statement must report information such as the name of the vaccine, the date it was administered, potential side effects, the overall benefits of vaccination, and information on how to report adverse reactions.
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