Publix offers customers access to a variety of immunization services. They can choose from a range of immunizations, including some of those recommended by the Centers for Disease Control and Prevention (CDC). These vaccinations protect against illnesses, including influenza, pneumonia, and shingles. Pharmacists can also administer other vaccines, such as travel-related vaccines, and provide advice on which immunizations may be necessary. However, all customers requesting vaccines must sign a Publix immunization consent form. The easiest and fastest way to create these essential documents is with our Publix Immunization Consent Form Template.
What Is a Publix Immunization Consent Form?
A Publix Immunization Consent Form is a document Publix Pharmacy and its partners use to obtain consent from individuals who wish to receive immunization services. The form is designed to ensure that the patient has been adequately informed of the risks and benefits of immunization and has consented to the procedure. This form must be completed and signed before any vaccine can be administered. The document also outlines the patient’s rights and responsibilities. Patients need to read the form carefully before signing.
Essential Elements of Publix Immunization Consent Form
The essential elements of a Publix Immunization Consent Form include extensive sections on precautions and contraindications and a lengthy consent statement, among other features. Publix divides its consent forms into large blocks with numerous subdivisions within each category for easy access. We’ve created a brief overview here so you know what to expect on your template.
- Pharmacy Logo and Document Title- At the top of the page, place the Publix pharmacy logo and “Immunization Consent Form.)
- Primary Information- This section holds information about the customer, including an emergency contact, spaces for medicare and Publix Personnel information if applicable, and a checklist for which vaccines the customer is requesting.
- Precautions and Contraindications Checklist- The precautions and contraindications segment is divided into items relevant to all vaccines and those that only apply to live vaccines. It should list all conditions or medical concerns for which the customer must speak to the pharmacist before receiving an immunization. There is a statement to this effect at the bottom.
- Consent Statement- The Publix-approved consent statement is extensive and includes agreements saying the customer has read and understood information, accepts the risks, requests the vaccines, gives Publix permission to share medical information, and a waiver, among other essential components.
- Signature and Date Lines- The patient, parent, or legal guardian signs and dates here. If the customer receiving the vaccines is under 18, the person signing for them must also indicate their relationship.
- Pharmacy Use Only- This section is filled out by a Publix pharmacist and includes the following:
- Billing- How the customer paid or who is charged for the service.Vaccine Administration Record- This standard chart includes vaccine data, the lot number, location, VIS, and other essential health data to be included in the patient’s record.
- Pharmacist, Store, and Drug Protocol Information- Here, you’ll print your name and sign, list the store number, drug protocol number, and physician’s name.
Immunizations When a Patient Has Contraindicated Conditions
When a patient has a contraindicated condition, they should not be given an immunization without first consulting with their doctor. A contraindicated condition is one in which a medical intervention could harm the patient’s health.
Common contraindicated conditions for immunizations include: severe allergies, a severe reaction to a previous vaccination, pregnancy, cancer, autoimmune diseases, and weakened immune systems.
In the case of a patient with a contraindicated condition, it is essential to discuss the risks and benefits of receiving an immunization with the patient’s healthcare provider. The provider will help determine if vaccination is appropriate for the patient. In the case of hives or other hypersensitivity reactions to immunization, it is crucial to discuss with the provider if a different immunization schedule can be given that would not cause an allergic reaction.
FAQs
Below we’ve included answers to some of the most frequently asked questions about this topic. Here you can learn more about which vaccines are live, how many a person can get at one time, how long tetanus shots last, and other vital information.
Publix uses the quadrivalent flu vaccine, designed to protect against four different influenza virus strains. The quadrivalent flu vaccine contains two influenza A viruses and two influenza B viruses. The two influenza A viruses are an H1N1 virus and an H3N2 virus, while the two influenza B viruses are a Yamagata lineage virus and a Victoria lineage virus. This type of vaccine is recommended for people 6 months and older, including pregnant women.
A tetanus shot typically protects for up to 10 years. However, it is recommended that people receive a booster every 10 years to ensure continued protection against tetanus. Additionally, if someone sustains a deep wound or puncture injury, doctors may suggest receiving a booster shot, even if it has been less than 10 years since the last one.
Generally speaking, adults can receive up to four vaccines at once. However, the number of vaccines that can be administered at one time may vary depending on the type of vaccine and the individual’s health status. For example, if an adult is immunocompromised or has a weakened immune system, they may not be able to receive as many vaccines at once. Some vaccines may require additional doses or boosters to be effective, so speaking with a healthcare provider is vital to determine the best course of action.
The number of vaccines a child can receive at one time depends on the child’s age and the type of vaccines being administered. For infants and toddlers, the Centers for Disease Control and Prevention (CDC) recommends that children receive multiple vaccines simultaneously as long as they are from different vaccine families. This means a child can receive up to five vaccines in one visit. For children aged four years and older, the CDC recommends that no more than two vaccines be given in one session, with a maximum of three in rare cases.
It is important to note that these recommendations are based on available scientific evidence and are not meant to be a hard-and-fast rule. Some vaccines can be given separately, such as the measles vaccine, which is only given to children at least 1 year old, and the MMR vaccine, which is recommended for all children under 12 months. In many cases, the CDC recommends that these vaccines should be given in separate visits, but there is no hard limit on how often they can be administered.
Giving two live vaccines at the same time is generally not recommended. This is because the body may not respond adequately to both vaccines, resulting in a reduced immune response to one or both of them. Examples of live vaccines include measles, mumps, and rubella (MMR), varicella (chickenpox), rotavirus, and the nasal spray flu vaccine.
In addition, certain combination vaccines that contain both live and inactivated components should not be given simultaneously as other live or inactivated vaccines. Examples of combination vaccines include the DTaP-H ib-IPV and the DTaP-IPV vaccines, Diphtheria, and tetanus vaccine, DT (Td)Diphtheria, tetanus, and pertussis vaccine, Tdap Pertussis (Tdap) Tetanus toxoid adsorbed (Td) Pertussis toxin adsorbed (Tdap).Bordetella pertussis vaccine, B Pertussis.
Live vaccines contain a weakened form of the virus or bacteria that causes the disease. When administered to a healthy individual, the weakened state of the virus or bacteria stimulates the immune system to develop antibodies that protect against the disease. Examples of live vaccines include MMR (measles, mumps, and rubella), chickenpox, rotavirus, and yellow fever. Live vaccines generally provide longer-lasting protection than inactivated vaccines.
Disclaimer
This template is provided as an educational and informational resource only and should not be considered a substitute for professional legal or medical advice. The user of this template should be aware that laws and regulations vary from state to state. It is essential to consult a licensed attorney for specific advice about the laws and regulations applicable to the user’s particular situation. The publisher and authors of this document do not make any representations or warranties as to the accuracy or completeness of the information presented in this document and assume no responsibility for any errors or omissions. Please consult your local Publix for more details on which immunization consent forms they accept.
Final Thoughts
The Publix Immunization Consent Form is a document Publix pharmacies use to obtain consent or approval for administering immunizations or vaccinations. The form provides all necessary information about immunization and its risks, including potential side effects and contraindications. It also outlines the patient’s and healthcare provider’s rights and responsibilities. The form is designed to be completed by both the patient and the healthcare provider. By choosing a professionally designed Publix Immunization Consent Template, you can easily save time and create a complete document for customers who wish to obtain immunizations.
