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HARFORD COUNTY HEALTH DEPARTMENT 20152016 ELEMENTARY SCHOOL INFLUENZA NASAL SPRAY () VACCINE CONSENT FORM Student Last Name: Student First Name: School: Student Date of Birth: Students Teacher: Age
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How to fill out 20152016 elementary school influenza:

01
Obtain the 20152016 elementary school influenza form from the appropriate educational authority.
02
Carefully read the instructions provided on the form to ensure that you understand the requirements and necessary information.
03
Begin by entering the personal details of the student, such as their full name, date of birth, and grade level.
04
Provide the contact information of the student's parent or guardian, including their name, phone number, and email address.
05
Complete the medical history section by accurately reporting any pre-existing conditions or allergies that the student may have.
06
If applicable, indicate whether the student has received the influenza vaccine and provide the date of administration.
07
Sign and date the form to confirm that the information provided is accurate to the best of your knowledge.
08
Submit the completed form to the designated authority or individual responsible for collecting and processing the influenza forms.

Who needs 20152016 elementary school influenza:

01
Elementary school students: The 20152016 elementary school influenza form is specifically targeted towards students attending elementary school.
02
Parents or guardians: It is the responsibility of parents or guardians to complete and submit the influenza form on behalf of their child.
03
Educational authorities: The 20152016 elementary school influenza forms are typically collected and processed by educational authorities, who use this information for monitoring and preventing the spread of influenza within the school community.
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20152016 elementary school influenza refers to the reporting of influenza cases within elementary schools during the school year 2015-2016.
Elementary school administrators or designated school health personnel are required to file 20152016 elementary school influenza.
20152016 elementary school influenza can be filled out by recording the number of influenza cases among students and staff, along with any related information requested.
The purpose of 20152016 elementary school influenza is to track and monitor the spread of influenza within elementary schools for public health and safety purposes.
Information such as the total number of confirmed influenza cases, age range of affected individuals, vaccination status, and any related absenteeism data must be reported on 20152016 elementary school influenza.
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