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ERIE CENTER ON HEALTH & AGING 406 Peach Street Erie PA 16507 (814) 4594132 INFLUENZA IMMUNIZATION CONSENT SCREENING QUESTIONNAIRE FOR INJECTABLE INFLUENZA VACCINE 1. Have you read over the Vaccine
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Provide accurate personal information such as your full name, date of birth, address, and contact details.
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The Erie Center on Health is a health center in Erie, Pennsylvania that provides healthcare services to the community.
Healthcare providers and organizations who operate within the Erie Center on Health are required to file.
To fill out the Erie Center on Health form, healthcare providers must provide information about their services, patients, and financial data.
The purpose of the Erie Center on Health is to track healthcare services provided in the Erie area and ensure that healthcare providers are meeting the needs of the community.
Information such as number of patients seen, types of services provided, and financial data must be reported on the Erie Center on Health form.
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