Form was filled out and downloaded 1,078 times already

Fillable Form Flu Shot Consent

A Flu Shot Consent Form is a written agreement to authorize a nurse or medical practitioner to proceed with the flu shot or vaccine.

  • fill online FILL ONLINE
  • fill online EMAIL
  • fill online SHARE
  • fill online ANNOTATE

How to Get and Edit Flu Shot Consent template

Open the Flu Shot Consent template
Use PDFRun's PDF Editor and start filling out the sample template
Create a Free Account on PDFRun to save your document
Export your document, Download, Print or Send your Document via Email

Fill and sign Flu Shot Consent online and download in PDF.

What is a Flu Shot Consent Form?

A Flu Shot Consent Form is a document that declares the consent of a patient to receive a flu vaccine shot based on the recommendation of his or her physician or medical professionals. Aside from it being a document that serves as a medical record, it also informs a patient about important details that he or she needs to know to make an informed decision. It also protects the medical practitioner who will administer the vaccine from liability should complications arise.

While there are no federal requirements that informed consent is necessary for immunization via vaccines, there are state regulations regarding flu shots. Therefore, it is best to learn and know the regulations that govern flu shots in the state you live in. This prevents the concern that some medical practitioners could give or refuse to give a flu shot with verbal consent alone. Completing and signing a flu shot consent form avoids leaving the medical practice open to liability.

Influenza, or more popular as the flu, is a contagious respiratory illness caused by the influenza virus. It infects the nose, throat, and lungs of a person and can cause very mild to severe symptoms. In severe cases, death is a possibility. To prevent getting it, a yearly flu shot may be necessary. The influenza vaccine, also known as a flu shot, protects individuals against the infections that the influenza virus can cause.

Getting a flu shot is not required, but healthcare providers recommend it to avoid catching the infectious disease. However, some businesses can enforce a policy on requiring a company-wide flu vaccination, as the flu is highly contagious and can infect an entire workforce, resulting in a company suffering avoidable consequences.

An employee has the right to refuse to receive a flu shot; however, no law protects an employee from getting fired when he or she declines despite his or her employer ordering that the entire workforce should be vaccinated. In most cases, an employee cannot sue his or her company when he or she gets fired for refusing a flu shot. Nevertheless, a company must inform all applicants about its mandatory flu vaccination policy before they are hired. For instance, healthcare companies whose employees work with the public and have access to people whose immune system may be compromised may require their employees to receive a flu shot.

A flu shot consent form contains a series of questions that a medical practitioner will ask a patient to determine if the latter can receive a flu shot or not, as the vaccine may cause complications. The patient should answer the form truthfully as the side effects can range from minor to serious. Minor side effects include soreness at the area of the shot, headache, muscle aches, nausea, and fever. Serious side effects include swelling, dizziness, hives, hoarseness, difficulty breathing, and a fast heartbeat. If a patient experiences a long-lasting serious side effect, he or she must immediately seek medical attention as any serious side effect can be a sign of an allergic reaction or other unusual complications.

How to fill out a Flu Shot Consent Form?

Get a copy of Flu Shot Consent template in PDF format.

A Flu Shot Consent Form is usually a single-page document, requiring the information of a patient and a screening questionnaire that is useful to determine if he or she may receive a flu shot.

PDFRun has a Flu Shot Consent Form Template that a patient can fill out and sign to authorize a nurse or medical practitioner to administer a flu vaccine. In the case of a minor, a parent or legal guardian should sign the consent form.

To answer the flu shot consent form accurately, follow the guide below.

The first section requires information about the patient.

Patient Name requires the full legal name of the patient.

Date asks for the date the consent form was signed by the patient, parent, or legal guardian.

Select the gender of the patient.

DOB requires the date of birth of the patient.

Age requires the age of patient.

Phone asks for the phone number that a medical practitioner can use to contact the patient.

Address asks for the full current address of the patient, including the city, state, and ZIP.

The patient should read the consent statement carefully before signing the consent form. If the patient agrees to give his or her consent, he or she must sign and provide the date of signing under the statement.

The Screening Questionnaire contains several questions that the patient should answer truthfully. The patient may mark the Yes, No, or Unknown box beside each question.

The last section of the document for official use.

Start filling out a Flu Shot Consent sample and export in PDF.

Frequently Asked Questions About a Flu Shot Consent Form

Do you need a consent form for the flu vaccine?

A vaccination requires the consent of the patient. To get a flu shot, a consent form is required to be filled out by the patient and given to the doctor. This is the case where a patient will receive an immediate benefit to protect them from illness, and thus it is not expected that they will flat out refuse.

When it comes to children, vaccines require even more consent than getting a flu shot, because the child is not expected to understand what they are doing at such an age where they do not reason as adults would. In the USA, parents who decide to vaccinate their children for all preventable diseases expect consent from their children because they know that if a kid is given no choice on the matter, the likelihood of them refusing it goes up immensely.

How do you document the flu vaccine administration?

To document a flu shot administration, the federal mandate requires specific elements to be included in the patient's permanent medical record such as:

  • The date of administration;
  • Vaccine manufacturer;
  • Lot number; and
  • The signature of the practitioner administering the dose.

These details should be documented in the permanent medical record and electronically included in a patient's EMR (electronic medical record) book.

For the first time, the CDC has issued a specific recommendation for documenting flu vaccination and other immunizations in EMRs. The CDC's goal is to provide medical practices with standardized templates that can be quickly implemented into an EMR's patient charting modules. The term "electronic medical record" (EMR) includes all of the electronic documentation of a patient's health care visit within a medical practice, such as diagnoses (ICD-9), procedures (CPT/HCPCS), and medications.

According to the CDC, using EMR templates "is essential for all public health practitioners who must provide data for programmatic, epidemiologic, or research purposes in order to ensure that accurate records are collected and maintained." The CDC's recommended techniques are currently being implemented by hospitals, clinics, private practices, ACOs (Accountable Care Organizations), health departments, public health departments, dispensaries, public health institutes/centers within the Department of Health and Human Services. The purpose is to standardize all forms of documentation, including the administration of the flu vaccine.

Can an employer legally require a flu shot?

Employers can require a flu shot if your job is "safety-sensitive". These include jobs where you could potentially do serious damage to someone if you're under the weather. This includes air traffic controllers, pilots, police officers, bus drivers, firefighters, and more. Nurses are also typically required to get flu shots for health care institutions during flu seasons.

For employers that don't require a flu shot, you can still be fired for not having one. Nevertheless, employers can only require their employees to get vaccinated if it is lawful and reasonable. In fact, some states like California and Illinois allow you to obtain employment without a flu shot.

Should I let my child have the flu vaccine?

Letting your child have the flu vaccine is up to your discretion as a responsible parent. Vaccines provide protection to your child which is why they are an important part of their early development. Without vaccines, children are prone to catching serious infections and may even die from them. That is why giving your child a vaccine on schedule is an excellent way to help their body defend itself against illnesses they might not survive otherwise. We trust our doctors, nurses, and healthcare providers with the life of our children so that they can get the best treatment possible.

Can schools give flu jabs without consent?

In general, schools cannot give flu jabs without consent. Nevertheless, primary and secondary school children may already give their own consent to be vaccinated. It is still wise that parents are informed and can make a decision about their children being vaccinated. If you are a parent, you should discuss with your child's school their policies on vaccination.

Can you ask employees if they have been vaccinated?

Employers may ask their employees if they have been vaccinated for purposes such as determining the risks associated with the job. It is therefore important for employees to understand what vaccines are, why they are required, and what illnesses they protect against. However, requiring employees to get vaccinated is another case entirely. So, is it legal for an employer to require employees to get vaccinated? The answer depends on the different situations.

For instance, health care professionals must be vaccinated against several serious infectious diseases. For some jobs that require constant contact with clients, being vaccinated is important. Moreover, in some cases of a pandemic, the public health authorities will require everybody in a city to get a vaccine or be quarantined in their homes. Some employers have included this type of situation in their policies, stating that their employees must be vaccinated against the latest infectious diseases.

However, generally speaking, employers do not have the right to require their employees to get vaccinated without good cause for doing so. For example, if an employee works at a company whose main assets are computers or computer hard drives, there is generally no risk of contracting any disease from them. In such a case, the employer cannot require its employees to get vaccinated unless they present a good cause.

Can you force an employee to get vaccinated?

You cannot force an employee to get vaccinated. Also, if you require employees to receive vaccinations, you must be willing to pay for their vaccines and you have them sign an informed consent document. Nevertheless, if your company policy is to only hire vaccinated people, you may refuse to hire unvaccinated people.

How long does it take to develop immunity after vaccination?

To develop immunity after flu vaccination takes a week or two, and a person is considered protected from the flu for about six months. However, manufacturers of the vaccine are allowed to claim that it triples the chance for immunity.

What is the purpose of a flu shot form?

The purpose of a flu shot consent form is to ensure that a patient understands and is willing to accept the risks of receiving the flu vaccine. It serves as protection in case there are any health problems that may arise due to the flu vaccine. Before receiving the flu shot, a consent form must be signed by the patient. Most doctors' offices have their own individual forms, which are generally available at the office. A person can also obtain a consent form from the Centers for Disease Control and Prevention website. By filling out and signing a flu shot consent form, you will be stating that you completely understand what is about to happen and that you are aware of all possibilities. It is important to understand that you can refuse if you are not willing to take the risk and that is acceptable.

It is interesting to note that in most cases, an adult patient does not need a parent or guardian present when signing the flu shot consent form. This means that if you are 18 years of age or older, you can sign your own consent form.

For children who are between 6 months and 18 years of age, they cannot legally give their consent. In the case of a child needing a flu shot, a parent or legal guardian needs to provide consent on their behalf. It is important to note that only one legally qualified person has to give consent for a child to be vaccinated.

In some cases, a patient may need a second vaccine if he/she has received one in the past and the doctor wishes to provide a second dose. When this happens, then both of the legally qualified persons will need to sign the consent form.

There are certain exceptions in cases where a patient cannot receive a flu vaccine without breaking the law. For example, if someone is confined to a correctional facility or has been sentenced to serve time in the custody of the state department of corrections, then they are not allowed to receive a flu shot.

What questions do you ask before giving a flu shot?

Before giving a flu shot, a flu shot form has questions that should be asked of the patient. These questions are called, screening questions. Screening questions will help determine if a patient is eligible to receive the flu shot or not based on their medical history. The questions should answer medical history, allergies to medicines or vaccines, existing medical conditions, and other health-related information.

What should be in a flu shot consent form?

A flu shot consent form must specify that vaccination is voluntary and there are risks associated with being vaccinated. It must also have a screening checklist that a patient should answer truthfully and accurately to determine his or her eligibility to receive a flu shot. Lastly, the patient must sign the consent form to provide his or her consent to get vaccinated.

How do I write a consent letter?

To write a flu shot consent letter, you must specify your agreement to receive a flu shot and agree to take responsibility for its risks and benefits. You may also need to sign a consent letter if you want your child to receive the flu vaccine.

Provide your written consent by signing the document. Once you have signed, date the letter to show that it is your informed consent for your doctor or clinic to administer a flu shot.

It's up to you to decide whether or not you want to receive a flu vaccine, but you must consider certain risks before taking this step. Your doctor may be able to cover these risks with a consent form. This may help you understand the benefits and risks of taking a flu vaccine, along with possible side effects that could occur after receiving the vaccine.

The consent letter must be written in layman's terms to avoid confusion or misinterpretation on your part. It can be helpful to read other flu shot consent letters first before writing your own.

Your doctor or nurse should review the letter with you before giving you the vaccine. Make sure that all of your questions are answered and that you fully understand what is written in your consent letter before making a decision to get vaccinated.

If any changes occur after receiving a flu shot, mention them in your follow-up appointment so they can be properly assessed.

There are several risks involved in getting a flu vaccine, so you have to be well-informed before deciding to take this step. You should discuss these risks with your doctor or nurse and keep them informed of any changes that occur after you receive the vaccine.

If you decide to get vaccinated for the upcoming flu season, ensure that you have a flu shot consent letter ready to take to your doctor or clinic.

At the time of vaccination, make sure that you understand everything in your letter and that any questions are answered before getting the vaccine.

Who signs a consent form?

The person who will be receiving the flu shot should be the one to sign the consent form. This ensures that he or she has thought about the possible risks and benefits. The patient's doctor or nurse should go over all of the information on the consent form. If there are questions, then these questions should be answered before signing the form.

If the patient is a minor, then a parent should review the consent form and sign it.

Why does a flu shot consent form need a signature?

A flu shot consent form needs a signature to be valid. Without a signature, the flu vaccine will not be administered.

Signing a flu shot consent form confirms that the vaccination is voluntary and that the patient understands potential side effects. This protects the healthcare professional administering the vaccine from potential legal liability if the vaccine causes problems.

Signing the flu shot consent form helps protect the patient, too. The patient has chosen to get the vaccine, rather than run the risk of getting sick.

How do you explain a consent form?

A consent form is used to document informed consent, which is required for medical procedures. The form outlines the fact that an individual has agreed to participate in a procedure. A signed or verbal agreement between the patient and researcher may be used.

The informed consent document should not be confused with other written records such as enrollment forms, medical histories, or medical records. The informed consent document exists to give the people involved in the study information about what is expected of them, and their rights.

How do you obtain consent?

To obtain consent for a vaccination procedure, a patient must answer and sign a vaccination consent form. Usually, a health care provider provides a vaccination consent form to a patient to read and sign. There are various forms, all taking different positions on issues related to the safety of vaccines and vaccine injuries. If the patient has questions, the health care provider may answer them. If the patient is unsure, he or she can consult family members and friends. If all questions are answered and issues resolved to the satisfaction of the patient, then he or she should sign the vaccination consent form before receiving a vaccine.

If you are the one providing your consent, be prudent and read or ask all the necessary questions you may have for your peace of mind and protection. Do not just sign a vaccination consent form just because your medical provider insists you should, or because it's the law.

Inform yourself as much as possible before consenting to vaccination. Know what is in each vaccine and its potential side effects.

Can you self-administer a flu shot?

There are now self-administered flu shots; however, it is still recommended to go to your healthcare provider to receive your flu shot.

How does the live flu vaccine work?

The live flu vaccine works by stimulating the human immune system to attack flu viruses in much the same way it would if you were exposed to a live virus. It uses weakened or dead viruses that cannot cause serious illness and is given by shot into the upper arm. The nasal spray version, or LAIV (Live Attenuated Influenza Vaccine), contains attenuated viruses and has been shown to be effective in clinical trials.

How often should you get a flu shot?

The Centers for Disease Control and Prevention recommends annual flu vaccination for all people six months of age or older as the first and most important step in protecting against this serious disease.

Are flu shots effective?

Seasonal flu viruses are unpredictable. The flu vaccine is reformulated each year to protect against the anticipated influenza viruses for the upcoming season. However, some variability in effectiveness is expected because global surveillance and testing indicate that not all influenza viruses respond to vaccination equally well. This means that protection may vary from season to season and among different age groups.

Create a Flu Shot Consent document, e-sign, and download as PDF.


Related Forms

You May Also Like

Are you looking for another form or document?

site badges site badges site badges site badges site badges site badges site badges