Get La Kenner Discount Pharmacy Hepatitis A & B Consent Form & Vaccine Administration Record 2013-2025

Filling out the LA Kenner Discount Pharmacy Hepatitis A & B Consent Form & Vaccine Administration Record online is an important step towards protecting your health. This guide will provide you with clear, step-by-step instructions to help you complete the form with ease.

Follow the steps to successfully fill out the consent form online.

1. Press the ‘Get Form’ button to obtain the consent form and open it in your preferred document editing interface.
2. Begin by entering the required personal information in the designated fields, including your name, date of birth, address, age, city, phone number, state, and zip code.
3. Indicate any allergies by checking the relevant boxes, including latex, baker’s yeast, alum, and the preservative 2-phenoxyethanol.
4. Respond to the vaccination history questions: Have you ever been vaccinated for hepatitis A or B? Use the options Yes, No, or Don’t know to answer.
5. State whether you have started the series of hepatitis vaccinations by selecting Yes or No.
6. Indicate if you are currently a patient at the pharmacy by selecting Yes or No.
7. If applicable, advise the pharmacy of your pregnancy status by selecting Yes, No, or Don’t know.
8. Indicate your interest in receiving more information about applicable wellness programs by checking Yes or No.
9. Provide the name and address of your family physician in the corresponding field.
10. Review the consent statement to ensure you understand the benefits and risks of the hepatitis vaccination. Then, sign and date where indicated, either for yourself or as an authorized person.
11. Complete the acknowledgment of notice of privacy practices by signing and dating in the provided section.
12. Once you have filled out all sections, review your entries for accuracy. Save changes, and you may choose to download, print, or share the completed form as needed.

Complete your documents online today and take a proactive step towards your health.