A consent form must be completed and signed by each person before administering any flu shot. The consent form screens the participant for contraindications to the vaccine, acknowledges the VIS has been made available and also collects vaccine information (manufacturer, lot number, etc.).
— Flu Shot Consent Form (English)
— Flu Shot Consent Form (Spanish)
— High-Dose/Adjuvanted Flu Shot Consent Form (English)
— High-Dose/Adjuvanted Flu Shot Consent Form (Spanish)
A Vaccine Information Statement (VIS) produced by the CDC must be made available to participants prior to receiving a vaccination.
— Inactivated Flu Vaccine Information Statement (VIS) English
— Inactivated Flu Vaccine Information Statement (VIS) Spanish
The administrating physician order will be included in the event paperwork. These must be reviewed by each administering nurse before the day of the event and brought on-site with you.
— Flu Vaccine & Epinephrine – All states except Georgia and New York
— Flu Vaccine & Epinephrine – New York
— Flu Vaccine & Epinephrine – Georgia (Fill out in advance)
— Flu Vaccine & Epinephrine – Georgia (Fill out at the event)
Georgia
Prior to 2021 nurses who administered shots in Georgia were required to offer an immunization card to participants. TotalWellness is no longer shipping the wallet-sized cards to Georgia events, but the forms are available below if you would like to use them.
Georgia Immunization Card (Individual Card)
Georgia Immunization Card (Printable Sheet of Cards)
Nevada
The state of Nevada requires that an Immunization Registry opt-out form be made available to participants who receive flu shots in the state. Copies of the opt-out form will be included in your shipment. Make the opt-out forms available, and collect completed opt-out forms.
Nevada Immunization Registry Opt-Out Form
— Vaccine Storage and Transportation Log
— Flu Event Information and FAQ’s
— Registration Table Tent
We usually have a pretty large volume of flu events. Some of these, you might even be tasked with working on your own. If you’re the primary contractor, you’ll receive, return and transport all paperwork, supplies and vaccine to and from events. Check out our General Event Paperwork page to access specific event paperwork you’ll need if you are working as the primary contractor.
© TotalWellness. All Rights Reserved.
9320 H Court, Omaha, NE 68127 | 402.964.0542