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VACCINATION CONSENT FORM
I have been given a copy of the August 7, 2015, Vaccine Information Statement for influenza vaccine and the
Nevada County Community Health Services Notice of Privacy Practices.
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It is a form used to report income or payments received.
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Individuals or businesses who have received income or payments must file i have been given.
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The purpose of i have been given is to report income or payments received and ensure compliance with tax regulations.
What information must be reported on i have been given?
You must report details of the income or payments received, including the amount, payer information, and any applicable taxes.
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