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Web i request that the pneumococcal vaccination be given to me (or the person named above for whom i am authorized to make this request). Web 2009 h1n1 influenza vaccine consent form for intramuscular, injectable formulation of vaccine. Health care providers are required by law to record certain information in a patient’s medical record. Web for children 6 months of age to less than 9 years of age who have not been previously vaccinated with seasonal influenza.
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Web influenza vaccine does not cause flu. Influenza vaccine may be given at the same time as other vaccines. Web i understand the benefits and risks of influenza vaccine and request that the vaccine be given to ☐ me ☐ my child. Each year a new flu vaccine is made to protect against the influenza viruses believed to be likely to cause disease in.