Spanish H1N1 Vaccine Consent Form

Keywords / Description:

This one-page Word document is a Spanish consent form that was used by the Knox County Health Department for school-located H1N1 vaccination clinics. The form instructs parents to return the form to school if they wish their child to receive the live attenuated influenza vaccine (LAIV) FluMist. Standard personal information and medical history are collected about the student.

This tool was submitted as part of an H1N1 Story from the Field. The story can be found at this link: http://www.naccho.org/topics/H1N1/h1n1story.cfm?story_id=293

Toolkit:

Influenza Toolkit

Keyword Area:

Cultural Competency, Immunization, Pandemic Influenza, School

Jurisdiction:

Institutional Author:

Knox County Health Department

Submitted:

02/03/2010

Modified:

02/23/2010

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