Get Inactivated Polio Vaccine (ipv) Consent Form - Norco College - Norcocollege

Filling out the Inactivated Polio Vaccine (IPV) Consent Form is a straightforward process that ensures your understanding and agreement regarding the vaccine. This guide provides a clear, step-by-step approach to assist you in completing the form accurately and efficiently.

Follow the steps to complete the IPV Consent Form with ease.

1. Press the ‘Get Form’ button to access the IPV Consent Form and open it in the designated editor.
2. Begin by answering the first question regarding any life-threatening reactions you may have had to the polio virus. Select ‘Yes’ or ‘No’.
3. The second question pertains to allergies. Indicate if you are allergic to neomycin, , polymyxin B, 2-phenoxyethanol, or formaldehyde by choosing ‘Yes’ or ‘No’.
4. For the third question, state if you have an illness with a fever on the day of the vaccination, selecting ‘Yes’ or ‘No’.
5. If applicable, fill in the date of your last menstrual period in the designated field.
6. Read the information on the Vaccine Information Sheet (VIS), ensuring that you understand the benefits and risks associated with the Inactivated Polio Vaccine.
7. The form requires you to print your last name and first name, along with your date of birth, age, street address, student ID number, telephone number, city, state, and zip code.
8. Finally, provide your signature and the date to confirm your understanding and agreement regarding the vaccine.
9. For clinic use, the provider will complete details related to the dose, manufacturer, lot number, expiration date, injection site, and their signature.
10. Once you have filled out the form, ensure that all information is accurate, then save your changes if prompted. Download or print the document as needed for your records or to submit it to the relevant clinic.

Complete your IPV Consent Form online today to protect your health.