Get the free Influenza Vaccine Declination 2015-2016 - ucdmc ucdavis

University of California Davis Medical Center, Employee Health Services 2221 Stockton Blvd. Cypress Bldg, Ste. A Sacramento, CA 95817 9167343572 Fax 9167347510 Influenza Vaccine Declination 20152016

How to fill out influenza vaccine declination 2015-2016

How to fill out influenza vaccine declination 2015-2016:

1. Locate the influenza vaccine declination form for the 2015-2016 season.
2. Provide your personal information, including your name, date of birth, and contact information, in the designated fields.
3. Indicate the reason for declining the influenza vaccine. This could include medical contraindications, religious beliefs, or personal preference.
4. If there is a specific section for medical contraindications, provide any relevant medical information or documentation as required.
5. Read the declaration statement carefully and sign and date the form to confirm your declination.
6. Follow any additional instructions provided on the form, such as returning it to a specific department or handing it to your healthcare provider.

Who needs influenza vaccine declination 2015-2016:

1. Individuals with medical contraindications: Some people may have underlying medical conditions or allergies that prevent them from receiving the influenza vaccine. In such cases, a vaccine declination form allows them to formally state their inability to receive the vaccine.
2. Individuals with religious beliefs: Certain religious beliefs may prohibit individuals from receiving vaccines. The influenza vaccine declination form allows them to exercise their religious freedom and indicate their choice to decline the vaccine on religious grounds.
3. Individuals who prefer not to receive the vaccine: Some individuals may choose not to receive the influenza vaccine due to personal preference or other reasons. The declination form provides a way for them to formally express their decision.

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