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Vaccine Information Statement (VIS) and

Updated Vaccine Consent Records

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The purpose of this presentation is to:

• Reinforce the use of the Vaccine Information Statement (VIS)

• Provide information on the use of the Vaccine Consent Record

• Provide information on the links to the CDC website and the Vaccine Consent Record (adult and pediatric) that are found on Forms Central

Purpose of Presentation

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Program Objectives

Objectives

at the end of this presentation, participants will be able to:• Cite the Federal Law requirement• Locate Vaccine Information Statements (VIS) provided

by CDC via the Forms central link• Locate the Vaccine Consent record for adult and

pediatric patients

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Informed Consent

Informed Consent:• The Vaccine Information Statement provides written information

relative to the risk and benefits of the vaccine

• Federal Law mandates that every patient/parent (guardian) receives (and gets a chance to review) the most current copy of the appropriate Vaccine Information Statement (VIS) prior to the administration of each immunization. It is part of the informed consent process

• A signature from the patient/parent (guardian) verifies that we have complied with this mandate

• This signature is required in addition to the Consent for Treatment and Payment Agreement

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How to locate the most updated and appropriate Vaccine Information

Statement (VIS)

• The most updated VIS can be located via the Kaleidascope’s web-link to the CDC

• This link is found on Forms Central under Vaccine Information Statement

• VISs are also available in multiple languages via the web-link

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Link to the CDC website from “Forms Central”

• http://www.cdc.gov/vaccines/pubs/vis/default.htm

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Mandatory Patient / Parent (Guardian) Signature

• The mandatory patient / parent (guardian) signature consent record can ordered through req-direct

• Pediatric Vaccine Consent Record-KH01103

• Adult Vaccine Consent Record-KH00453

Or

• Can be printed “on demand” via Forms Central

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Kaleida HealthAdult Vaccine Consent Record

This is what the ADULT

CONSENT form looks like.

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Pediatric Vaccine Consent Record

Front Back

This is what the Pediatric CONSENT Record looks like:

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Inpatient Influenza/Pneumococcal Immunization Program

Important Note: All in-patient charts have a PLUE-generated Vaccine Information Statement (VIS) for Pneumococcal and Influenza (seasonal)

The Process for obtaining consent for Influenza/Pneumococcal Immunizations is as follows:

1. The patient reviews the PLUE- generated Vaccine Information Statement (VIS) and agrees to the vaccine.

2. The patient must sign the chart copy

3. Chart copy is scanned to pharmacy to obtain the dose for the patient

4. Patient is given the Patient Copy of the Vaccine Information Statement

Dose can be administered once this process is complete

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Required Elements of Electronic PowerChart Documentation

1. Name of vaccine

2. Date and time of administration

3. Name of healthcare provider administering vaccine (name only)

4. Vaccine Information Statement (VIS) date of publication

5. Dose

6. Unit of measure

7. Route of administration

8. Site of administration

9. Manufacturer of the vaccine

10.Lot number (#)

11.Expiration date of the vaccine

The following information regarding the vaccine must be recorded in PowerChart:

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Updated Policies

The following vaccine policies have been recently updated and are found on Kaleidascope:

1) CL6 Adult Inpatient Influenza/Pnemococcal Immunization Program

2) CL18 Immunization of Adult (except for Influenza and Pneumococal Vaccines)

3) CL51 Pediatric Immunizations, In-patient and Out-patient

4) MAT09 Immunization of Female Patient 9-26 for Human Papilloma Virus

5) MAT60 Rubella Vaccine Administration for the Post-Partum Patient

6) MAT 73 Hepatitis B Screening and Immunization-Maternity/Pediatrics

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Thank you for your attention