Getting a flu shot is a relatively recent event in human history since it only became available to the public in 1945. However, the widespread use of consent forms for flu shots is even more recent and began in the 2000s as vaccine awareness, misinformation, and concerns about the potential adverse effects caught the public’s attention. The original forms were brief, including just a little information and a signature from the recipient. Today’s Infuenza consent forms are much more complete, containing more detailed information about the vaccine, asking relevant health questions, discussing risks and side effects, and even providing instructions for what to do in case of an adverse reaction. We recommend using our professionally designed Influenza Consent Form Template to create a high-quality document for your flu shot patients, as it’s vital to be transparent about this process. A template helps eliminate human error, saves time, and ensures you have a place for all the relevant information on these legal documents.
What Is Influenza Consent Form?
An Influenza Consent Form is a document that outlines the risks associated with getting an influenza vaccine and requests a person’s signature to signify that they understand and accept those risks. The form includes information about the potential side effects of the vaccination, as well as any benefits that may be provided. This document also provides important legal protection for healthcare providers who administer vaccines. By signing the Influenza Consent Form, patients acknowledge that they are aware of the risks and voluntarily consent to receive the vaccine. This document may be used in conjunction with materials, such as informational pamphlets or videos, which further explain the risks associated with this type of vaccine.
Why is Influenza Consent Form Needed?
Influenza consent forms are necessary documents that must be signed by a patient or parent or guardian before receiving a flu vaccine. This is to ensure that people getting flu shots understand the risks, potential side effects, and benefits of receiving the vaccine. It is essential to ensure that the recipient, parent, or guardian is aware of these facts so they can make an informed decision.
The consent form also serves as a record of the conversation between the healthcare provider and the recipient. Signing the document shows that they have discussed the risks and potential side effects with the provider and that they voluntarily consent. Here are all the reasons why you should always have a signed Influenza consent form before administering treatment.
- It respects and protects patient rights
- It encourages open, honest discussion
- It states the risks, benefits, and side effects of the vaccine
- It fosters a better relationship between the public and the medical community through transparency
- It contains information about the vaccine
- It asks relevant health questions
- It adheres to laws regarding informed consent and medical recordkeeping
- It creates a legal contract between parties
- It protects the medical personnel administering the vaccine against litigation
- It creates a record of the consent and treatment for the patient’s medical file
Who Should Get a Flu Shot
Unless your doctor directs you otherwise, or you are allergic to one of the ingredients, everyone 6 months of age and older should get a flu shot each year. Typically, this includes pregnant women, people with chronic health conditions, those living in nursing homes or other long-term care facilities, individuals at high risk of developing serious flu complications (65 years and older, asthmatic, chronic diseases), and healthcare workers.
Essential Elements of Influenza Consent Form
The essential elements of an influenza consent form contain a lot of information. The essential elements of an influenza vaccine consent form contain a lot of information. This vital document includes the bio-information, their medical history, details of the supervising physician/healthcare worker, vaccination history, amongst other essential information. To help you better understand and create these documents using your template, we’ve provided an overview below that explains what information belongs on the form. The outline below contains information for both Influenza and Pneumococcal immunization consent, as the two are often given together.
- Name of Business or Practice Giving The Immunization- This indicates the name of your practice, health department, or other location where influenza shots are given.
- Form Title- The form title shows what the patient is reading and signing in large bold print at the top.
- Patient Information- Include space for their name, date of birth, and gender.
- Patient Contact Information- Have the patient write their address, county of residence, and phone number here.
- Patient Medicare, Policy Number, and Insurance Information- The medicare and insurance information are for billing purposes. You may include a self-pay option if the vaccine is paid for out of pocket.
- (As Needed) Under 19 Mother’s Maiden Name- While this is not required everywhere, states such as New York need this information for anyone under 19.
- Doctor’s Name and Address- This is information for their primary care physician so the records can be updated appropriately.
- Site of Vaccination- Indicate where the shot is being given. This section is especially important for pharmacies and other businesses with multiple locations throughout the city and state.
- (As Needed) NYSIIS Permission or Similar- NYSIIS and other state health organizations require special permissions for minors, but you can leave this off your document if it’s not relevant in your area.
- Patient Medical Questions- Make a checklist of all the relevant health information you must collect, such as recent immunizations, fever, allergies, and whether the patient has ever had an influenza shot before. Make sure to include all relevant inquiries.
- Influenza Consent Statement With Signature and Date Line- This states clearly that the patient has read, discussed, and understood the form and vaccine, accepts the risks, and requests the influenza vaccine.
- Administration Site and Dosage Data- Note where the shot is administered, such as the right or left arm, and its dosage.
- Vaccine Data- Vaccine data includes facts such as the VIS date, lot number, and manufacturer.
- Nurse Signature- Have the nurse who administers the vaccine sign here.
- Next Immunization Date- When relevant, indicate the earliest date for the patient’s next vaccine.
- Pneumococcal Consent Statement With Signature and Date Line- This states clearly that the patient has read, discussed, and understood the form and vaccine, accepts the risks, and requests the pneumococcal vaccine. Please Note: Patients can request one vaccine without the other if they choose.
- Administration Site and Dosage Data- Note where the shot is administered, such as the right or left arm, and its dosage.
- Vaccine Data- Vaccine data include facts such as the VIS date, lot number, and manufacturer.
- Nurse Signature- Have the nurse who administers the vaccine sign here.
- Next Immunization Date- When relevant, indicate the earliest date for the patient’s next vaccine.
- (As Needed) Document ID and Copy Color Indicator- The document ID is primarily used by medical facilities and health departments. Copy color indicator shows the original, provider, and patient copy color, typically white, yellow, and pink in that order.
Pro Tip: Including sections on the risks and side effects and instructions about what to do in case of an adverse reaction is optional in most places but always a good idea. However, being familiar with your local laws and standards for creating immunization consent forms is vital, as these may vary from state to state. If you are uncertain, please consult an attorney or your licensing board for further information on this topic.
When and How Often Patients Should Get Flu Shots
It is recommended that you get a flu shot every year. The influenza virus constantly changes, so this year’s vaccine may not protect you against next year’s strain. It is recommended to get your flu shot every year before the start of the flu season, which usually begins in October and lasts through May. The best time to get a flu shot is in October or November, just before the flu season starts.
FAQs
Below we’ve included more information about this topic’s most frequently asked questions. You’ll learn all about when to provide the patient with information on the cost of vaccination and special considerations when obtaining consent from patients with underlying health conditions, among other helpful facts.
Including information about potential vaccine shortages or delays in the influenza consent form is a good idea. It can help patients understand the potential risks of getting the vaccine and make an informed decision. It can also help prevent disappointment or frustration if they find out later that they may not be able to receive the vaccine due to a shortage or delay. Additionally, it can give healthcare providers a chance to explain any alternative options that may be available, such as receiving a different type of vaccine or taking other preventive measures to protect against the flu.
There are special considerations for obtaining consent from individuals who are pregnant or have underlying health conditions. When obtaining consent from pregnant individuals, it is crucial to ensure they are fully informed of the risks and benefits associated with the procedure or treatment, including the potential risks to their unborn child. It is vital for individuals with underlying health conditions to ensure they are fully aware of any potential risks associated with the procedure or treatment and understand how their condition may affect the outcome. Additionally, it is vital to ensure that pregnant, elderly, immunocompromised, and other at-risk patients discuss getting a flu vaccine with their primary care physician before agreeing.
If an individual decline to sign the influenza consent form, the first step should be to explain the importance of signing the document and the risks associated with not signing it. It is essential to provide clear and accurate information about the form’s purpose and what it entails. If the individual still declines to sign the consent, it is important to document their refusal in writing and have them sign a statement indicating that they understand the risks associated with not signing the form. It is also vital to ensure that all other necessary steps are taken to protect the individual’s health and safety. This process may include providing additional education about influenza, offering alternative ways to protect their health and well-being, and ensuring that the individual is not put at risk by their refusal.
When obtaining informed consent for the influenza vaccine, you should provide the patient with information about the cost of the vaccine. Doing this helps to ensure that the patient is aware of any financial obligations associated with receiving the vaccine and can make an informed decision about whether to proceed. Additionally, providing cost information in the consent form can help ensure that patients are not surprised by any unexpected fees when receiving their vaccine. However, fee information is unnecessary when flu vaccines are given for free.
If an individual is unable to sign the influenza consent form due to a disability, incapacitation, or other health conditions, they should provide alternate documentation of their consent. A family member or legal guardian may provide written permission on the individual’s behalf. In some cases, the individual may be able to provide verbal or electronic consent, but you should always check the local laws and standards before accepting alternative consent. Moreover, in these cases, the individual’s healthcare provider should be consulted to determine the best course of action for obtaining their consent.
Final Thoughts
Influenza, or “flu,” is a serious virus that can cause severe illness and even death. The influenza consent form is essential for patients and healthcare providers. It outlines the risks and benefits of receiving the influenza vaccine and the patient’s rights and responsibilities when receiving the shot. Providing this form to patients before they receive the vaccine helps ensure that they are fully informed of the potential risks and benefits of the vaccine and that they are making an informed decision to receive it. The consent form should always be read in its entirety. Additionally, it can protect healthcare providers from potential liability in the event of any adverse reactions to the vaccine. By using a professional influenza consent form template, you can quickly create a high-quality document for your patients that you can modify over time and use for years to come.
