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Adult Influenza & Pneumococcal Vaccine Consent Form rev 7/11 ...
Adult Influenza & Pneumococcal Vaccine Consent Form rev 7/11. AGE. ***This is to be used for Patients aged 19 and older ONLY***. Direct Data Entry to New .
http://www.immunizenm.org/documents/AdultFluPnemoForm_72011-finalcopy.pdf

 

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Seasonal Influenza and Pneumococcal Vaccine Consent Form
Seasonal Influenza and Pneumococcal. Vaccine Consent Form. Region______________________________. Clinic Location .
http://www.gov.mb.ca/health/flu/docs/flupneumo_consentform.pdf

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Influenza/Pneumococcal Immunization Consent Form
No Yes Are you (your child) currently sick with a fever? No Yes Do you (your child ) have a severe allergy to eggs, latex or an ingredient of the flu or .
http://www.health.ny.gov/forms/doh-4156.pdf

Flu Administration Sheet2010
VACCINE ADMINISTRATION CONSENT FORM . have had explained to me the information about influenza/ pneumonia and influenza/pneumonia vaccine[s].
http://www.doh.state.fl.us/chdalachua/clinicfamilyhealth/docs/fluConsent2010.pdf

FLU/Pneumo Vaccination Consent Form For Adults (2011)
Page 1. FLU/Pneumo Vaccination Consent Form For Adults. Clinic Site: Clinic Date: ____/____/2011. Date of birth: ___/___/______. First Name: Last Name .
http://www.tompkins-co.org/health/flu/flu-consent-form-adult_2011.pdf

Health Care Provider Influenza Immunization Toolkit
Influenza vaccination of HCP has been proven to lead to: . Adults · Vaccine Information Statements (VIS); Influenza/Pneumococcal Immunization Consent form .
http://www.health.ny.gov/prevention/immunization/toolkits/hc_provider/

Vaccines: Pubs/VIS/Fact Sheet
Jan 20, 2012 . Vaccine Information Statements: Fact Sheet. . There is no Federal requirement for written informed consent for vaccinations, and VISs are not informed consent forms, . Pneumococcal Conjugate (PCV13): 4/16/10 (Interim) .
http://www.cdc.gov/vaccines/pubs/vis/vis-facts.htm

IMMUNIZATION CONSENT FORM
IMMUNIZATION CONSENT FORM . Have you ever received the pneumonia vaccine before? ?. ?. If no, Maxim will administer the pneumonia vaccine. If yes .
http://www.stolaf.edu/services/hr/newsletter/August&September2010/2010Fluconsent_Private%20Pay.pdf

Seattle Visiting Nurse Association INFLUENZA and] or PNEUMONIA ...
Seattle Visiting Nurse Association INFLUENZA and] or PNEUMONIA VACCINATION CONSENT FORM. A. PATEENT INFORMATION - Please Print - ' .
http://seattlevna.com/2012_Patient_Consent_Form.pdf

Pneumococcal Conjugate Vaccine - What You Need To Know
Pneumococcal (against Pneumonia) Vaccination Consent Form. I have read and understood the above information about Pneumococcal (against Pneumonia) .
http://www.immunize-la.com/vaccination_information/pneumococcal_information.pdf

Steve Darrish,

Senior Vice President

Bank of America

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