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This document serves as a formal declination for influenza vaccination by a healthcare worker, acknowledging the risks of influenza and the implications of not being vaccinated.
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How to fill out declination of influenza vaccination
How to fill out Declination of Influenza Vaccination
01
Obtain the Declination of Influenza Vaccination form from your employer or healthcare provider.
02
Read the instructions on the form carefully.
03
Fill out your personal information, including your name, date, and contact details.
04
Indicate your choice to decline the influenza vaccination by checking the appropriate box.
05
Provide a brief reason for your declination if required by the form.
06
Sign and date the form to confirm your declination.
07
Submit the completed form to the designated authority in your organization.
Who needs Declination of Influenza Vaccination?
01
Employees in healthcare settings who are eligible for the influenza vaccination but choose not to receive it.
02
Individuals with medical or religious exemptions that require documentation of their declination.
03
Workers in schools or daycare settings where vaccinations may be recommended.
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People Also Ask about
Why am I not eligible for the flu vaccine?
Who cannot have the flu vaccine. Most people who are eligible for the flu vaccine can have it. You only cannot have the vaccine if you've had a serious allergic reaction (anaphylaxis) to a previous dose of the vaccine or an ingredient in the vaccine. Some of the flu vaccines used in the UK contain egg protein.
What are the reasons for flu shot exemption?
There are medical reasons that the flu shot is not for everybody- are called medical exemptions. You should not get the flu shot if you have a documented severe allergy to the vaccine or any vaccine component or if you have a history of Guillain-Barré Syndrome within 6 weeks of a receiving a flu shot.
What are valid reasons to decline a flu shot?
6 reasons patients avoid flu vaccination I'm healthy, so I don't need a flu vaccine. The flu vaccine isn't safe and can give me the flu. It is better to get sick with the flu. I'll wait until flu hits my area. I hate getting injections. I was vaccinated last year.
What to write to decline the flu vaccine?
I DO NOT WANT A FLU SHOT. I acknowledge that I am aware of the following facts: Influenza is a serious respiratory disease; on average, 36,000 Americans die every year from influenza-related causes. Influenza virus may be shed for up to 24 hours before symptoms begin, increasing the risk of transmission to others.
What are valid reasons to decline the flu vaccine?
6 reasons patients avoid flu vaccination I'm healthy, so I don't need a flu vaccine. The flu vaccine isn't safe and can give me the flu. It is better to get sick with the flu. I'll wait until flu hits my area. I hate getting injections. I was vaccinated last year.
How to get religious exemption for flu shot?
California removed its personal and religious exemption option in 2015. Parent/guradian must complete an online educational module to receive a non-medical exemption. Connecticut removed its religious exemption option in 2021.
What to put on flu declination form?
I AM DECLINING THE FLU SHOT. This facility recommended I receive the influenza vaccination in order to protect myself and the patients I serve. I decline the vaccination at this time, while acknowledging my awareness of the following facts: Influenza is a serious respiratory disease.
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What is Declination of Influenza Vaccination?
The Declination of Influenza Vaccination is a formal statement provided by individuals who choose not to receive the influenza vaccine, indicating their refusal and the reasons for it.
Who is required to file Declination of Influenza Vaccination?
Typically, healthcare workers and other employees within healthcare settings are required to file a Declination of Influenza Vaccination if they opt out of receiving the vaccine.
How to fill out Declination of Influenza Vaccination?
To fill out the Declination of Influenza Vaccination, individuals usually need to complete a provided form that includes personal identification information, their refusal statement, and any specific reasons for declining the vaccine.
What is the purpose of Declination of Influenza Vaccination?
The purpose of the Declination of Influenza Vaccination is to ensure that individuals formally communicate their decision to not receive the vaccine and to provide healthcare organizations with necessary documentation for compliance and record-keeping.
What information must be reported on Declination of Influenza Vaccination?
The information reported on the Declination of Influenza Vaccination typically includes the individual's name, position, the date of the declination, and the reason for declining the vaccination.
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