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This document is a declination form for healthcare workers who choose to refuse influenza vaccination, outlining the risks of influenza and the importance of vaccination.
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How to fill out declination of influenza vaccination
How to fill out Declination of Influenza Vaccination
01
Obtain the Declination of Influenza Vaccination form from your employer or healthcare provider.
02
Read through the entire document to understand the implications of declining the vaccination.
03
Fill in your personal information where required, including your name, position, and date.
04
Locate the section that specifies your reason for declining the vaccination; choose or write a suitable explanation.
05
Review the organization's policy regarding flu vaccinations to understand any consequences of declining.
06
Sign and date the form to acknowledge that you understand the risks associated with not receiving the vaccine.
07
Submit the completed form to the appropriate department or individual as instructed.
Who needs Declination of Influenza Vaccination?
01
Individuals who are working in healthcare settings.
02
Employees in environments where influenza outbreaks may impact vulnerable populations.
03
Anyone wishing to formally decline the influenza vaccination based on personal beliefs or medical reasons.
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People Also Ask about
Why am I not eligible for the flu vaccine?
Who cannot have the flu vaccine. Most people who are eligible for the flu vaccine can have it. You only cannot have the vaccine if you've had a serious allergic reaction (anaphylaxis) to a previous dose of the vaccine or an ingredient in the vaccine. Some of the flu vaccines used in the UK contain egg protein.
What are the reasons for flu shot exemption?
There are medical reasons that the flu shot is not for everybody- are called medical exemptions. You should not get the flu shot if you have a documented severe allergy to the vaccine or any vaccine component or if you have a history of Guillain-Barré Syndrome within 6 weeks of a receiving a flu shot.
What are valid reasons to decline a flu shot?
6 reasons patients avoid flu vaccination I'm healthy, so I don't need a flu vaccine. The flu vaccine isn't safe and can give me the flu. It is better to get sick with the flu. I'll wait until flu hits my area. I hate getting injections. I was vaccinated last year.
What to write to decline the flu vaccine?
I DO NOT WANT A FLU SHOT. I acknowledge that I am aware of the following facts: Influenza is a serious respiratory disease; on average, 36,000 Americans die every year from influenza-related causes. Influenza virus may be shed for up to 24 hours before symptoms begin, increasing the risk of transmission to others.
What are valid reasons to decline the flu vaccine?
6 reasons patients avoid flu vaccination I'm healthy, so I don't need a flu vaccine. The flu vaccine isn't safe and can give me the flu. It is better to get sick with the flu. I'll wait until flu hits my area. I hate getting injections. I was vaccinated last year.
How to get religious exemption for flu shot?
California removed its personal and religious exemption option in 2015. Parent/guradian must complete an online educational module to receive a non-medical exemption. Connecticut removed its religious exemption option in 2021.
What to put on flu declination form?
I AM DECLINING THE FLU SHOT. This facility recommended I receive the influenza vaccination in order to protect myself and the patients I serve. I decline the vaccination at this time, while acknowledging my awareness of the following facts: Influenza is a serious respiratory disease.
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What is Declination of Influenza Vaccination?
Declination of Influenza Vaccination is a formal statement or document completed by individuals who choose not to receive the influenza vaccine, outlining their refusal.
Who is required to file Declination of Influenza Vaccination?
Individuals working in healthcare settings or other designated environments where influenza vaccination is strongly recommended or required may be required to file a Declination of Influenza Vaccination if they choose not to get vaccinated.
How to fill out Declination of Influenza Vaccination?
To fill out the Declination of Influenza Vaccination, individuals need to provide their personal information, acknowledge their understanding of the risks associated with not getting vaccinated, and sign the declaration form.
What is the purpose of Declination of Influenza Vaccination?
The purpose of the Declination of Influenza Vaccination is to document an individual's refusal of the vaccine, ensure awareness of the risks of influenza, and maintain compliance with institutional policies regarding vaccination.
What information must be reported on Declination of Influenza Vaccination?
The Declination of Influenza Vaccination must report the individual's name, position, a clear statement of refusal, acknowledgment of the risks involved, and the date of signing the document.
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