What Information Is Typically Requested on a Flu Vaccine Authorization Form?


Quick Answer

Information typically requested on a flu vaccine authorization form includes health information about the person to be vaccinated, answers to vaccine screening questions and the signature of the person giving consent, according to the Centers for Disease Control and Prevention. For parental vaccine authorization, the form may also request that parents choose the type of vaccine.

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Full Answer

In some cases, a flu vaccine authorization form requests that the consenting party agree to release demographic information to public health officials or the person's doctor, states the CDC.

Some flu vaccine authorization forms contain questions that allow the administering party to screen for potential interactions. The questions might cover recent illnesses, allergies to components in the vaccine, pregnancy and current medications, reports the Eric Cohen Student Health Center at the University of Southern California. In addition, the form may request that the recipient acknowledge that she is of legal age and that she understands the risks and benefits of the vaccine.

A vaccine authorization form also requests information about the recipient, including name, age and contact information, according to the Eric Cohen Student Health Center. The form typically ends with a statement of consent, a signature line and a space to enter the date. Depending on the organization, the form may also request a signature from a witness.

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