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POLICY NUMBER: DATE ESTABLISHED: March 25, 2013 HS80 DATE REVIEWED/REVISED: March 25, 2013, AUTHORIZED BY: HUMAN RESOURCES DEPARTMENT HUMAN RESOURCES POLICY SUBJECT: INFLUENZA VACCINATION PURPOSE:

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How to fill out wellspan health system influenza

Instructions on how to fill out the WellSpan Health System Influenza form:

01

Begin by carefully reading the instructions provided on the form. Make sure you understand the purpose of the form and the information it requires.

02

Fill in your personal details accurately, such as your full name, date of birth, and contact information. Ensure that you double-check the spellings and accuracy of these details.

03

Provide your medical information, including any existing conditions, allergies, or medications you are currently taking. It is important to be thorough and honest in this section.

04

Indicate your vaccination history by providing the dates and types of influenza vaccinations you have received in the past. If you have not been vaccinated before, leave this section blank.

05

If applicable, mention any previous adverse reactions or side effects you experienced after receiving an influenza vaccine. This information helps healthcare professionals understand your medical history better.

06

Sign and date the form to certify that the information provided is accurate and complete.

Who needs the WellSpan Health System Influenza form?

01

Individuals who are seeking influenza vaccination at any WellSpan Health System facility are required to complete this form. This ensures that the healthcare professionals administering the vaccine have all the necessary information about the patient's medical history and suitability for the vaccine.

02

It is particularly important for individuals with pre-existing medical conditions, allergies, or those taking certain medications to fill out this form. This information helps healthcare professionals assess any potential risks or contraindications before administering the vaccine.

03

Anyone who has never been vaccinated against influenza before will also need to fill out this form to provide their vaccination history accurately.

Remember, filling out the WellSpan Health System Influenza form accurately and honestly is crucial for the overall safety and effectiveness of the vaccination process.

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What is wellspan health system influenza?

Wellspan health system influenza is a form used to report influenza cases within the wellspan health system.

Who is required to file wellspan health system influenza?

All healthcare providers within the wellspan health system are required to file the influenza report.

How to fill out wellspan health system influenza?

To fill out the wellspan health system influenza form, healthcare providers must input relevant patient data and submit the report electronically.

What is the purpose of wellspan health system influenza?

The purpose of wellspan health system influenza is to track and monitor influenza cases within the healthcare system.

What information must be reported on wellspan health system influenza?

Relevant patient information such as date of diagnosis, age, gender, and vaccination status must be reported on the wellspan health system influenza form.

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