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SEASONAL INFLUENZA CONSENT FOR IMMUNIZATION 6 months old - 17 years old Section 1: Client Information (Parent/Guardian must complete) Last Name Health Card Number
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Document Date: 2014-09-16 13:00:59
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MedicalCondition
anaphylactic reaction /
Guillain-Barré syndrome /
list allergy /
allergies /
e.g. cancer /
influenza /
severe asthma /
medically attended wheezing /
disease /
/
MedicalTreatment
organ transplant /
Immunization /
/
Position
Nurse /
/
Product
prednisone /
/
SocialTag
AstraZeneca
Health
Influenza vaccines
Influenza
FluMist
MedImmune
Flu season
Influenza research
H5N1 clinical trials
Vaccination
SEASONAL INFLUENZA CONSENT FOR IMMUNIZATION 6 months old - 17 years old Section 1: Client Information (Parent/Guardian must complete) Last Name Health Card Number