Der origin? (Mandatory question) No Yes, Aboriginal Yes, Torres Strait Islander VACCINATION NEEDS ASSESSMENT - Do you answer yes to any of the following, please tick 3 Do you live with someone who is on immunity lowering treatment Do you live with someone who has a disease that lowers immunity? Have you been in contact with someone who is ill? Do you have a functioning spleen? Are you pregnant or planning pregnancy? GENERAL HEALTH AND SUITABILITY FOR VACCINATION Have you ever fainted after.
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How to fill out the AU Pharmacy Guild Consumer Vaccination Pre-Screening/Consent & Recording Form online
Completing the AU Pharmacy Guild Consumer Vaccination Pre-Screening/Consent & Recording Form online is a straightforward process designed to gather essential information for ensuring safe vaccination. This guide provides detailed, step-by-step instructions to help users complete the form effectively.
Follow the steps to complete the form accurately:
- Click ‘Get Form’ button to obtain the form and open it in your document editor.
- Begin by filling out your personal information, including your name, address, phone number, and date of birth. Ensure all details are accurate as they are crucial for your vaccination record.
- Indicate any allergies you might have. This information is vital for assessing your suitability for the vaccine.
- Provide your general practitioner's name and contact details to facilitate communication regarding your vaccination.
- Answer the mandatory question regarding your Aboriginal or Torres Strait Islander origin by selecting 'Yes' or 'No'.
- In the vaccination needs assessment section, tick 'Yes' for any statements that apply to you, such as living with someone on immunity-lowering treatment or being in contact with someone who is ill.
- Next, assess your general health and suitability for vaccination by answering questions about prior reactions to vaccines, current health status, and any chronic illnesses.
- Read the consent section thoroughly. Confirm your agreement to receive the influenza vaccine and acknowledge understanding of the information provided regarding possible side effects.
- Sign and date the form to confirm your consent. Ensure that you also provide pharmacy details where the vaccination will take place.
- If applicable, have the authorized immunizer sign the form. Make sure the pharmacy details are correctly filled out.
- Finally, review your completed form for accuracy. Save your changes, and download, print, or share the form as needed.
Complete your vaccination pre-screening form online today to ensure a smooth and safe vaccination experience.
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