Get the free Influenza Declination Form - Tulsa Community College - tulsacc

Tulsa Community College HEALTH SCIENCES PROGRAMS Guide to Student Immunizations INFLUENZA VACCINATION DECLINATION FORM Student Name CID# Date (You may rescind the declination once the series is completed,

How to fill out influenza declination form

How to fill out influenza declination form:

1. First, obtain the influenza declination form from your employer or healthcare provider.
2. Read the instructions on the form carefully to understand the information needed.
3. Start by filling out your personal details, including your full name, date of birth, and contact information.
4. Indicate whether you are accepting or declining the influenza vaccination by checking the appropriate box.
5. If you are declining the vaccination, provide a reason for your decision if required.
6. Sign and date the form to confirm your decision.
7. Return the completed form to your employer or healthcare provider as instructed.

Who needs influenza declination form:

1. Employees who are not receiving the influenza vaccination may be required to fill out an influenza declination form. This is particularly common in healthcare settings, where the flu vaccine may be mandatory for staff.
2. Some employers or organizations may also ask their employees or members to complete a declination form if they choose not to get vaccinated for other reasons, such as personal beliefs or medical conditions.
3. It is important to check with your specific employer or healthcare provider to determine if you need to fill out an influenza declination form and the procedures for doing so.

For pdfFiller’s FAQs

What is influenza declination form?

Influenza declination form is a document that allows individuals to officially decline receiving the influenza vaccine.

Who is required to file influenza declination form?

Individuals who are mandated to receive the influenza vaccine but choose to decline it are required to file the influenza declination form.

How to fill out influenza declination form?

Influenza declination form can usually be filled out by providing personal information, reason for declining the vaccine, and signature.

What is the purpose of influenza declination form?

The purpose of influenza declination form is to document and acknowledge an individual's decision to decline receiving the influenza vaccine.

What information must be reported on influenza declination form?

Information such as name, date of birth, reason for declining the vaccine, and signature are typically reported on the influenza declination form.

How do I complete influenza declination form online?

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