Get Addendum To Influenza Vaccine Forms

The Addendum To Influenza Vaccine Forms is a vital document that facilitates the cooperation between individuals receiving the influenza vaccine and healthcare providers. This guide provides clear steps to assist users in completing this form online with confidence and accuracy.

Follow the steps to fill out the Addendum To Influenza Vaccine Forms effectively.

1. Click ‘Get Form’ button to access the Addendum To Influenza Vaccine Forms and open it in an editable format.
2. Fill in the details of the person who will receive the vaccine. Provide their last name, first name, and middle initial as prompted.
3. Enter the birthdate of the individual receiving the vaccine in the format mm/dd/yy.
4. Indicate the clinic or office address where the vaccine will be administered, including the street, city, county, and state information.
5. Select the sex of the individual receiving the vaccine by circling either 'M' for male or 'F' for female.
6. Complete the date when the vaccine will be administered.
7. Record the vaccine manufacturer and the lot number of the vaccine.
8. The individual receiving the vaccine or their authorized representative must sign to indicate consent.
9. Fill in the site of injection, and ensure the vaccine administrator also provides their signature along with the date and title.
10. Review the form for accuracy, then save changes, download a copy, print it, or share it as necessary.

Complete your Addendum To Influenza Vaccine Forms online today to ensure timely processing.