同意疫苗接种最新的疫苗信息表(VIS)已可以阅读。我了解他们的内容,特此同意接受(或让我的孩子接收)流感疫苗。我了解此同意对推荐的剂量数量有效。是的,我授予护士授权审查并将这种疫苗的管理到vactrak,该疫苗是由阿拉斯加州,卫生与社会服务部管理的疫苗接种记录系统,流行病学部分。
STOP AT THE RED LINE ____________________________________________________________________________________ PAYMENT o No Cost Employee___________________ Employee ID number____________ Volunteer/Intern/Student (circle one) Vender/Contractor-Place of work and contact phone __________________________________________________ Received sticker for badge________ FOR NURSES Name of Vaccine: ________________ Lot #: ____________ Exp.日期:_________
§ 流感疫苗有效期一年, 每年需接种一次。凡9 岁以下从未接种过流感疫苗的儿童, 均须接种两剂流感疫苗, 而两剂疫苗的接种时间须至少相隔四个星期§ 不宜接种流感疫苗人士:对鸡蛋丶新霉素(Neomycin) 丶庆大霉素(Gentamycin) 或流感疫苗有过敏反应的人士;在注射当日身体不适或发烧的人士都不宜接种。 § 曾对鸡蛋有严重过敏反应的人士, 应由专业医护人员在能识别及处理严重敏感反应的适当医疗场所内接种。流感疫苗内虽含有卵清蛋白(即鸡蛋白质) , 但疫苗制造过程经过反覆纯化, 卵清蛋白的含量极少, 即使对鸡蛋敏感的人士, 在一般情况下亦能安全接种。 § 流感疫苗十分安全,除了接种部位可能会出现痛楚、红肿外,一般并无其他副作用。部分人士在接种后6 至12 小时内可能会出现发烧、肌肉疼痛,以及疲倦等症状,这些症状通常会在两天内减退。如持续发烧或不适,请咨询医生意见。若出现罕见的风疹块、 口舌肿胀、手脚麻痹、无力及呼吸困难等不良反应,患者必须立即求医。 § The vaccine is effective for 1 year; you should take the influenza vaccine annually. Children under 9 years old who have never received any influenza vaccine are recommended to have 2 doses of influenza vaccine with a minimum interval of 4 weeks § People who are allergic to eggs, Neomycin, Gentamycin or flu vaccine; and/or people who have fever should not take influenza vaccine 。 § Individuals with a history of anaphylaxis to eggs should have seasonal influenza vaccine administered by health care professionals in appropriate medical facilities with capacity to recognize and manage severe allergic reactions. Influenza vaccine contains ovalbumin (a chicken protein), but the vaccine manufacturing process involves repeated purification and the ovalbumin content is very little. Even people who are allergic to eggs are generally safe to receive vaccination 。 § Inactivated influenza vaccine is very safe and usually well tolerated, apart from occasional soreness, redness or swelling at the vaccination site. Some people may experience fever, muscle pain, and tiredness beginning 6 to 12 hours after vaccination. These usually improve in two days. If fever or discomfort persists, please consult a doctor. Severe allergic reactions like hives, swelling of the lips or tongue, and difficulties in breathing, or serious adverse events such as limb numbness or weakness are rare but require emergency consultation.
3.申请父母提交唯一申请权的主要证据,例如以下之一:x 孩子经认证的美国或外国出生证明,仅列出申请父母 x 海外出生报告 (FS-240) 或海外出生证明 (DS13-50),仅列出一位父母 x 授予唯一监护权的法院命令(除非该命令限制孩子的旅行) x 收养令(仅列出申请父母) x 法院命令明确允许申请父母或监护人与孩子一起旅行 x 非申请父母无行为能力的司法声明 x 非申请父母的死亡证明或
我们在此不可撤回地同意,作为向士兵提供的免费军事医疗的一部分,我们可以在孩子同意的情况下对其进行所有必要的医学治疗和检查(例如疫苗接种、超声波、放射诊断、测力计、输液、实验室检查和牙科治疗等)。
我已经充分了解了疫苗接种的重要性和疫苗的潜在副作用。我同意在适当的情况下披露相关信息。从3。这张表格给我的GP实践,以帮助他们为我和4的照顾。地方卫生委员会(LHB)和NHS威尔士共享服务合作伙伴关系。5。我同意由训练有素的药剂师进行流感疫苗接种。
授权成人同意书:我被授权同意上述患者接种此疫苗。我请求为上述患者接种疫苗。我理解患者在接种疫苗后应在疫苗接种点停留 15 至 30 分钟,以监测潜在的疫苗相关即时反应和副作用,并在必要时接受医疗干预。_______________________________________,___________________________________,__________ 授权成人签名 授权成人印刷姓名 日期 或 对于疫苗接种点:_______________________ 于 ___________ 向 _________________ 口头表示同意