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Pharmacy: Eisner's Pharmacy

Address: 79 High St
Mansfield, VIC, 3722

Phone: 0357752028

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COVID-19 Vaccination

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COVID-19 Vaccination

Duration: 5 min

COVID-19 Vaccination

Flu Vaccination

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Flu Vaccination

Duration: 5 min

Flu Vaccination

MMR Vaccinations

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MMR Vaccinations

Duration: 10 min

MMR Vaccinations

Pneumococcal Vaccination

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Pneumococcal Vaccination

Duration: 5 min

Pneumococcal Vaccination

RSV Vaccination

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RSV Vaccination

Duration: 10 min

RSV Vaccination

Shingles Vaccinations

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Shingles Vaccinations

Duration: 10 min

Shingles Vaccinations

Whooping Cough (Pertussis) + Tetanus + Diphtheria

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Whooping Cough (Pertussis) + Tetanus + Diphtheria

Duration: 5 min

Whooping Cough (Pertussis) + Tetanus + Diphtheria

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First Name*

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Medicare Number

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Name on card

Enter your Medicare number and other details to reduce your waiting time in the pharmacy.

Date of birth*

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Reason for consultation*

What are you experiencing with your health? Provide information to help with the consultation.

Relevant background information*

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I am consenting as a substitute decision-maker (e.g. carer) on behalf of the patient

Name of substitute decision-maker*

Consent to pilot clinical service and costs*

If applicable, I agree to participate in the Queensland Community Pharmacy Chronic Conditions Management Pilot and understand the scope of the clinical service. I consent to paying the pilot consultation fee and any costs associated with the service. I understand that if I decide not to proceed with receiving some part of a service, I may still be required to pay for services that have already been provided. I understand that my pharmacist will inform me if this is applicable to my situation.

Consent to pilot evaluation*

If applicable, I consent to participating in the evaluation of the Queensland Community Pharmacy Chronic Conditions Management Pilot and agree to being contacted to participate in surveys about the pilot. I consent to my administrative health service data being analysed for evaluation purposes. I understand that my pharmacist will inform me if this is applicable to my situation.

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I have read and accept the Guild Corporate Health Privacy Policy. I give consent for the pharmacy to provide my personal information to my employer for reconciliation and program management purposes. *

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This program closes at 4pm AEST July 31st. Do not book a vaccination after this date/time.

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