It is spread through droplets that have been coughed or sneezed by someone who has the flu. Tennessee coverrx covered drug list effective february 12. According to the public health agency of canada, the best way to prevent the flu is to have a flu vaccination each year, in the late fall. Flu vaccinations will be offered at shoppers drug mart stores in the fall in. Harris teeter cares about each of the communities in which we are located, and we offer convenient seasonal flu shots each year in our pharmacies.
Ask your pharmacist which vaccines are right for you. Flushot influenza flu informed consent consent given by patientagent i, the undersigned client, parent or guardian, have read or had explained to me information about the flu shot as outlined on th e flu shot fact sheet. How well the vaccine works changes from one influenza season to another. This section must be completed and then the form can be submitted by fax or email to your zone contact. The flu shot consent form must be completed before a influenza vaccine is administered. Association influenza vaccination toolkit, which includes resources such as a template for. Below is a list of common symptoms of the flu compared with a common cold. The influenza vaccine provider registration form contains a request for vaccine storage information. Available in three design variation, these templates are fully editable you can change the sample texts, color schemes and place a new photo on the photo placeholders.
By getting immunized, you protect yourself and those close to you during the flu season. You could miss school, work, parties, holidays, or even end up in the hospital. In actual practice obtaining informedconsent is not a linear process but part of a more fulsome conversation with, and assessment of, the client. Even though a pharmacy chain is on the list, every local virginia. If you have allergies and asthma, treat your allergies to reduce symptoms that may worsen asthma symptoms. Seasonal influenza flu immunization program accessing. Flushot influenza flu informed consent consent given by patientagent i, the undersigned client, parent or guardian, have read or had explained to me information about the flu shot as outlined on th e flu. Influenza flu is a respiratory viral infection that can lead to severe complications. We offer a convenient immunization service for adults on a walkin or. Get daytime and nighttime relief with rexall coldflu relief. Request pdf impact of pharmacists as immunizers on vaccination rates. Since the virus causing the flu changes from year to year, the flu vaccine you received last year may not protect you this year. The uiip offers influenza vaccine free of charge each year to all individuals six months of age and older who live, work or go to school in ontario.
This record is evidence andor documentation that you have received the flu vaccine, and it will be filed with the wellness company inc. Daytime relief is nondrowsy, alcohol and antihistamine free, and for relief of aches, fever, cough, and nasal congestion. Drug information for rexall daytime nighttime cold and flu by dolgencorp inc. Getting a flu shot or other immunizations is as easy as going to your safeway pharmacy. Available in three design variation, these templates are fully editable you.
The most effective way to prevent the spread of influenza is by getting a flu shot and washing your hands regularly. Flu vaccines are proven to be safe by health canada. Declination form for influenza vaccine unc charlotte. Talk to your walmart pharmacist about the best way. Food andor other anaphylactic allergy management 8,17. Vaccine administration record var informed consent for vaccination healthcare providers can be an immunizationcertified pharmacist or a registered nurse, licensed practical nurse, licensed vocational nurse, nurse practitioner, physician or physicians assistant. The following provides information about the ontario ministry of health the ministrys universal influenza immunization program uiip for the 20192020 influenza season. This section must be completed and then the form can be submitted by fax or email to your zone. They will record what vaccine was given, when the vaccine was given, where the vaccine was given, the name of the company that made the vaccine, the vaccines lot number, and the name. I confirm that i have read the attached vaccine information sheet regarding the risks, benefits and potential side effects associated with the vaccine. Yes no failure to select one of these boxes will result in the vaccine documents being sent to my primary care. The document ensures that the receiver of the vaccination is aware of the process and side effects, and that theyve had ample opportunity to field any questions they may have. By provincial legislation, pharmacists cannot administer a flu shot to children. Rexall cold and flu multisymptom rapid release combo, 24ct.
The quadrivalent vaccine will be offered and selffunded groups will be. Home phone date of birth age gender male female physician. Rexall night time cold and flu solution dolgencorp inc. I authorize the pharmacist to send copies of my vaccine documents to my primary care provider. Tennessee coverrx covered drug list effective february 12, 2020.
The cdc recommends that anyone who is over the age of six months should receive the influenza vaccine. Rexall apologizes for marketing to customers who got flu. Our highly qualified staff can easily administer these immunizations here at. You will receive confirmation of program enrolment through the 20192020 medical officer of health. Nighttime relieves fever, aches, cough, sneezing and running nose. The document ensures that the receiver of the vaccination is aware of the process and side effects, and that theyve. The intent of the informedconsent process is to have the seven steps covered as part of a clientcentered visit. Immunization is one of the most important accomplishments in public health that has, over.
What retail pharmacies are participating in the flu shot program. Flu seasons vary in severity, however every year children are at risk cdc estimates that since 2010, flu related hospitalizations among children younger than 5 years old have ranged from 7,000 to 26,000 in the united states. Do you have any heart, lung, or diabetic condition. Rexall daytime nighttime cold and flu kit dolgencorp inc.
The stores, having roots in the federation of united drug stores starting in 1903, licensed the rexall brand. Seasonal influenza vaccine for residents of longterm care. The flu, more properly known as seasonal influenza, is a common contagious infection. Even though a pharmacy chain is on the list, every local virginia pharmacy in that chain may not be participating. Impact of pharmacists as immunizers on vaccination rates. Are you currently under a physicians care for any medical condition e. Updated november 19, 2019 getting the flu vaccine is the best way to prevent the flu or reduce the risk of complications. The vaccine consent form includes options allowing you to either accept or refuse the vaccination for your child. Please drop off this form to student health services or fax to 75000605. Flu shot given for free, walkin, no appointment required shingles vaccine. Rexallca fill online, printable, fillable, blank pdffiller.
Have you had close contact with anyone with a severely weakened immune system. Oct 22, 2018 the influenza flu vaccine is free publicly funded and is offered to saskatchewan residents who are six months and older. Fill your prescription at any harris teeter pharmacy. These vaccines include the shingles vaccine as well as many common travel. Free flu shot influenza vaccine consent form pdf word. Influenza information for health professionals city of. Influenza information for health professionals city of toronto. The influenza vaccine is the best way to lower your risk of getting influenza and its complications. Universal influenza immunization program uiip ministry. Inactivated influenza vaccine consent and administration.
These vaccines include the shingles vaccine as well as many common travel vaccines. These scenarios demonstrate the informedconsent process only. To get a form, pharmacists may contact the ontario pharmacists association. Get daytime and nighttime relief with rexall cold flu relief. It has never been easier to get a flu shot in ontario and it is the best way to protect your family, coworkers, friends and yourself. All rexall pharmacists take part in a certification process that includes. It is the professional and legal responsibility of health care providers to obtain informed consent prior to immunization. Is it possible to get vaccinated too early in the season. The influenza vaccine is available at no cost to the public through primary care providers, public health units, pharmacies for those 5 years of age and older, and in various other settings such as longterm care homes, workplaces, hospitals and community health centres. Our computer system connects our pharmacies and allows your confidential patient profile to be accessed by all our pharmacists.
Participating retail pharmacy chains and independents include a number of national pharmacy and grocery store chains. Vaccine administration record var informed consent for. Vaccine administration record var informed consent for vaccination healthcare providers can be an immunizationcertified pharmacist or a registered nurse, licensed practical nurse, licensed. We offer a convenient immunization service for adults on a walkin or appointment basis. Current your childs best shot, a parents guide to vaccination by the canadian paediatric society cps current red book, report committee on infectious diseases by the american academy of pediatrics canada communicable disease reports ccdr by health canada. If you refuse, the vaccination will not be given to your child. Retail chain rexall has apologized after sending out marketing material to customers who received flu shots at its pharmacies in ontario. Screening checklist for contraindications to inactivated. Diabetes could make your immune system less able to. In canada, influenza generally occurs each year in the late fall or winter months. The flu vaccine will not protect against colds and other respiratory illnesses not caused by the influenza virus. I am aware that i must contact public health branch if i have any questions, or if i have any.
This form must be completed if you receive your flu shot somewhere other than student health services. Rexall pharma plus, hanover 211 central east ontario. They will record what vaccine was given, when the vaccine was given. H1n1 influenza vaccine shot consentdeclination form the h1n1 influenza vaccine is offered free of charge as a benefit to all employees, volunteers and students who qualify for. Screening questionnaire and consent form amazon s3. Pharmacists cannot administer a flu shot to children under the age of 5 in the majority of provinces. The nurse or pharmacist is prepared to handle this. Immunizations tricare covers ageappropriate doses of vaccines, as recommended by the centers for disease control and prevention cdc tricare regularly adds coverage for new. Flu shot consent form version 201112 information about patient receiving vaccination please print.
Administer the flu vaccine to children as young as two years old renew prescriptions. If you dont get a flu shot, you will be expected to protect hospital patients by wearing a mask. Cdcrecommended for diabetes patients who are six months and older. In rare cases, flu complications can lead to death. In extremely rare instances, an allergic reaction may occur. You will receive a package from your childs school that contains a. Rexall pharmacists can administer many vaccines in addition to the flu vaccine.
The influenza flu vaccine is free publicly funded and is offered to saskatchewan residents who are six months and older. Immunization and flu shots getting a flu shot or other immunizations is as easy as going to your safeway pharmacy. At what age can someone get a flu shot from a pharmacist. Since the virus causing the flu changes from year to year, the flu. Acetaminophen 325mg, dextromethorphan hydrobromide 10mg, phenylephrine hydrochloride 5mg. The influenza vaccine can keep you from getting influenza and spreading it to your family and others. I have had the chance to ask questions, and answers were given to my satisfaction.
Flu seasons vary in severity, however every year children are at risk cdc estimates that since 2010, flurelated hospitalizations among children younger. Acetaminophen 650mg in 30ml, dextromethorphan hydrobromide 30mg in 30ml, doxylamine succinate 12. A flu shot influenza vaccine consent form is a written authorization that gives a nurse or other medical practitioner the goahead to administer the flu vaccine. A flyer template set perfect for promoting a flu shot or flu vaccination campaign. Oct 11, 2019 updated october 11, 2019 influenza occurs globally with an annual attack rate estimated at five to 10 per cent in adults and 20 to 30 per cent in children. Sign, fax and printable from pc, ipad, tablet or mobile with pdffiller instantly no software. Getting a flu shot at rexall or any community pharmacy is quick and convenient. Toolkit, which includes resources such as a template for patient consent forms, patient. H1n1 influenza vaccine shot consentdeclination form the h1n1 influenza vaccine is offered free of charge as a benefit to all employees, volunteers and students who qualify for vaccination based on cdcapic recommendations about who should get vaccinated this flu season. You can get the flu by shaking hands with someone who has the flu or by touching surfaces that have come into contact. While the fever declines on the second or third day of the illness, full recovery may take up to 6 weeks. The tabs below offer health professionals key information about influenza vaccination. Screening checklist for contraindications to inactivated injectable influenza vaccination patient name date of birth for patients both children and adults to be vaccinated.
The stores, having roots in the federation of united drug stores starting in 1903, licensed the rexall brand name to as many as 12,000 drug stores across the united states from 1920 to 1977. Drugs for rheumatoid arthritis, crohns disease or psoriasis. Acetaminophen 325mg, dextromethorphan hydrobromide 15mg, doxylamine succinate 6. Our pharmacy offers convenient, immunization service for adults on a walkin or appointment basis. Nov 19, 2019 updated november 19, 2019 getting the flu vaccine is the best way to prevent the flu or reduce the risk of complications.
Updated october 11, 2019 influenza occurs globally with an annual attack rate estimated at five to 10 per cent in adults and 20 to 30 per cent in children. Last name please print name of school parentguardian name first name middle. Administration of the publicly funded influenza vaccine. It takes two weeks for the vaccine to boost immunity. Talk to your walmart pharmacist about the best way to manage your cold, flu, and allergy symptoms and about getting your flu shot each year. Frequently asked questions for pharmacists ontario.
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