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Patient name Screening Checklist date of birth for Contraindications to Live Attenuated Intranasal Influenza Vaccination month / day / year For use with people age 2 through 49 years: The following
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How to fill out a screening checklist:

01
Review the entire checklist: Begin by thoroughly reading through the screening checklist to familiarize yourself with the sections and requirements.
02
Gather necessary information: Before filling out the checklist, gather all the relevant information, documents, and data that you may need to complete the screening checklist accurately.
03
Follow instructions: Pay close attention to any specific instructions provided in the checklist. For example, if it asks for information to be written in certain formats or requires supporting documents, make sure to comply with those instructions.
04
Complete each section: Go through each section of the screening checklist one by one, answering the questions or providing the requested information. Be honest and provide accurate responses.
05
Double-check for completion and accuracy: Once you have filled out the entire screening checklist, review it carefully to ensure that you have answered all the questions and provided the necessary information correctly. Double-check for any errors or omissions that may need to be corrected.
06
Seek clarification if needed: If you encounter any confusing or unclear aspects of the screening checklist, don't hesitate to seek clarification from the relevant authority or person responsible for the screening process.
07
Submit the checklist: Once you are satisfied with the accuracy and completeness of your responses, submit the filled-out screening checklist as per the provided instructions.

Who needs a screening checklist?

01
Individuals applying for a job: Job applicants may be required to fill out a screening checklist as part of the hiring process. The checklist helps employers evaluate the candidate's qualifications, skills, and suitability for the role.
02
Organizations conducting background checks: Companies or organizations that need to assess the background, qualifications, or integrity of potential employees or stakeholders may use a screening checklist to collect relevant information.
03
Institutions conducting security screenings: Airports, government agencies, and other security-conscious establishments often use screening checklists to ensure the safety and security of individuals by verifying their identity, travel history, or personal belongings.
04
Healthcare providers or clinics: Before receiving certain medical treatments or procedures, patients may be asked to complete a screening checklist to assess their medical history, current conditions, or any potential risks.
05
Housing providers or landlords: Landlords or property management companies may use a screening checklist to evaluate potential tenants' rental history, references, creditworthiness, and other relevant factors before entering into a lease agreement.
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The screening checklist is a document used to assess and evaluate individuals for potential risks or concerns before allowing them to participate in a specific activity or process.
The individuals responsible for conducting screenings are required to file the screening checklist.
The screening checklist should be filled out by providing accurate information about the individual being screened and answering all questions truthfully.
The purpose of the screening checklist is to identify any potential risks or concerns associated with an individual before they are allowed to participate in a specific activity or process.
The screening checklist should include personal information about the individual being screened, as well as any relevant background information or past incidents that may impact their eligibility.
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