Spanish H1N1 Vaccine Consent Form
Author: Knox County Health Department
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Spanish H1 N1 Vaccine Consent Form 1 id1926
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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
Program: Community Health
Submitted Date: Feb 03, 2010 | Modified Date: Sep 30, 2025
Primary Toolkit: Influenza Toolkit | Secondary Toolkit: Influenza Toolkit
Jurisdiction:
Institution Type: LHD - County,
Keywords: Influenza, Cultural Competency, Immunization, School Safety
