Because the idea of vaccinating children at school may be unfamiliar to some parents/guardians, there may be reluctance to consent to influenza vaccination at school. Flu Information and FAQs. Influenza virus changes often, making annual vaccination necessary. eCollection 2016.Isr J Health Policy Res. Declination of Influenza Vaccination Form pdf icon [65 KB, 1 page] external icon. METHODS: A combined form for documentation of vaccination consent, medical contraindication(s) for vaccination, or vaccination declination was used during the 2006-2007 influenza season in a healthcare system employing approximately 9,200 nonphysician employees in 3 hospitals; a skilled nursing care facility; a large, multisite, faculty-practice plan; and an administrative building. You must fully complete and submit this form or you will be considered non-compliant. Calendars with flu clinic locations, dates, times can be found below. 2019-2020 INFLUENZA VACCINE DECLINATION FORM PRINT NAME: _____ DOB: _____ I DO NOT WANT A FLU SHOT I acknowledge that I am aware of the following facts: • Influenza is a serious respiratory disease; on average, 36,000 Americans die every year from influenza-related causes. Epub 2010 Nov 3.Vaccine. INFLUENZA VACCINATION CONSENT/DECLINATION Consent The influenza virus vaccine is recommended for elderly and high-risk patients, their household contacts, healthcare personnel, and anyone who wishes to reduce the chance of catching influenza. Epub 2015 Apr 11.Bell S, Chantler T, Paterson P, Mounier-Jack S.Vaccine. I acknowledge that I am aware of the following facts (please read and check each box): Influenza is a serious respiratory disease. 60, RR-7 eCollection 2016.Lytras T, Kopsachilis F, Mouratidou E, Papamichail D, Bonovas S.Hum Vaccin Immunother. 2010 Nov 29;28(51):8061-4. doi: 10.1016/j.vaccine.2010.10.019. 2016 Dec 16;5:61. doi: 10.1186/s13584-016-0122-3. 60, RR-7,Infection Control in Health Care Facilities,Selecting Viruses for the Seasonal Influenza Vaccine,Influenza Vaccine Availability Tracking System, National Influenza Vaccine Summit,Vaccine Storage and Handling Toolkit, Centers for Disease Control and Prevention,Standing Orders for Administering Influenza Vaccine to Adults,This publication is available for ordering from the New York State Department of Health,Dosage, Administration and Storage of Influenza Vaccines,How to Administer Intramuscular, Intradermal, and Intranasal Influenza Vaccines, Immunization Action Coalition,How to Administer IM and SC Injections to Adults,Standing Orders for Medical Management of Vaccine Reactions in Children and Teens, IAC,Standing Orders for Medical Management of Vaccine Reactions in Adults, IAC,Declination of Influenza Vaccination for Health Care Personnel,New York State Immunization Information System (NYSIIS),Sample Primary Care Provider Notification of Vaccination Letter,Vaccine Adverse Event Reporting System (VAERS),NYSDOH Seasonal Influenza Educational Materials,NYSDOH, Vaccination of Health Care Personnel,NYSDOH Health Advisory: Recommendations for Vaccination of Health Care Personnel, 2016,Position Statements on Influenza Vaccination Policies for Health Care Personnel,Prevention Strategies for Seasonal Influenza in Healthcare Settings,Suggestions to Improve Your Immunization Services, IAC.Immunizing Health Care Personnel Against Influenza: A Report on Best Practices, National Foundation for Infectious Diseases.Recommendations on Strategies to Achieve the Healthy People 2020 Annual Influenza Vaccine Coverage Goal for Health Care Personnel, 2012,A Toolkit for Long-Term Care Employers: Increasing Influenza Vaccination Among Health Care Personnel in Long-term Care Settings, CDC,Addressing the Opioid Epidemic in New York State,Learn About the Dangers of "Synthetic Marijuana",Help Increasing the Text Size in Your Web Browser.reductions in HCP illness and absenteeism.HCP who receive influenza vaccine report approximately.reductions in health care-acquired influenza.Residents in nursing homes with high HCP vaccination levels have.Influenza vaccination has been estimated to save $13.66 per person vaccinated annually.All persons employed or affiliated with a health care or residential facility or agency, whether paid or unpaid, including but not limited to employees, members of the medical and nursing staff, contract staff, students, and volunteers, who engage in activities such that if they were infected with influenza, they could potentially expose patients or residents to the disease.Pre-book private stock influenza vaccine (for adults and privately-insured children) in January - February.Influenza Vaccine Medical Exemption Statement for Health Care Personnel. Content source: Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases (NCIRD) Page last reviewed: July 30, 2020.
Check calendars often as they are subject to change.All Beaumont team members must complete the new.If you are planning on getting the vaccination at an on-site flu clinic, you must complete the form prior to arriving at the clinic.Once logged in with single sign-on, click on the Forms tab at the top of the page, then select “2019-20 Influenza Vaccination Form.” You will need to answer a series of yes/no questions, even if you opt to decline the vaccination at the bottom of the form.If declining, you will first need to complete and submit the appropriate exemption form – see the “Exemption Forms” box on this page.