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This document provides information regarding the H1N1 vaccination for children in the Maine-Endwell School District, including consent forms and important vaccination details.
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How to fill out 2009 H1N1 Pandemic Influenza Vaccination Screening Questionnaire & Consent to Receive Vaccination
01
Begin by obtaining the 2009 H1N1 Pandemic Influenza Vaccination Screening Questionnaire and Consent form from your healthcare provider.
02
Fill in your personal information, including your name, date of birth, and contact details at the top of the form.
03
Answer the screening questions truthfully, indicating any allergies, previous vaccinations, or medical conditions.
04
Review the information provided in the consent section carefully, ensuring you understand the benefits and risks associated with the vaccination.
05
Sign and date the consent form at the designated areas, confirming your willingness to receive the vaccination.
06
Submit the completed form to the healthcare provider administering the vaccination.
Who needs 2009 H1N1 Pandemic Influenza Vaccination Screening Questionnaire & Consent to Receive Vaccination?
01
Individuals who are scheduled to receive the 2009 H1N1 Pandemic Influenza vaccine must fill out this questionnaire.
02
Parents or guardians should complete the form on behalf of minor children receiving the vaccine.
03
Anyone with prior medical conditions or concerns regarding vaccinations is encouraged to complete this form for proper assessment.
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What is 2009 H1N1 Pandemic Influenza Vaccination Screening Questionnaire & Consent to Receive Vaccination?
The 2009 H1N1 Pandemic Influenza Vaccination Screening Questionnaire & Consent to Receive Vaccination is a form used to assess an individual's eligibility for receiving the H1N1 vaccine, ensuring that they understand the benefits and risks associated with vaccination.
Who is required to file 2009 H1N1 Pandemic Influenza Vaccination Screening Questionnaire & Consent to Receive Vaccination?
Individuals who wish to receive the 2009 H1N1 vaccination are required to fill out this screening questionnaire and consent form as part of the vaccination process.
How to fill out 2009 H1N1 Pandemic Influenza Vaccination Screening Questionnaire & Consent to Receive Vaccination?
To fill out the screening questionnaire, individuals should provide their personal information, answer specific health-related questions, and indicate their consent to receive the vaccine by signing the form.
What is the purpose of 2009 H1N1 Pandemic Influenza Vaccination Screening Questionnaire & Consent to Receive Vaccination?
The purpose of the questionnaire is to evaluate whether the individual is a suitable candidate for vaccination based on their health status and to obtain their consent for receiving the vaccine.
What information must be reported on 2009 H1N1 Pandemic Influenza Vaccination Screening Questionnaire & Consent to Receive Vaccination?
The information that must be reported includes the individual's personal details, medical history, any allergies, current medications, and any previous reactions to vaccines.
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