Get the free 2015-2016 Influenza Vaccination AttestationDeclination Form OHSU - ohsu

20152016 Influenza Vaccination Attestation/Declination Form OSU recommends I receive influenza vaccination to protect the patients OSU serves. I attest that I have already received the influenza vaccination

How to fill out 2015-2016 influenza vaccination attestationdeclination

Point by point, here's how to fill out the 2015-2016 influenza vaccination attestation/declination:

1. Obtain the form: The 2015-2016 influenza vaccination attestation/declination form can usually be obtained from your healthcare provider or employer. If you cannot find a physical copy, check if it is available online.
2. Read the instructions: Take the time to carefully read the instructions provided on the form. This will guide you through the process and ensure you understand the purpose and requirements of the attestation/declination.
3. Provide personal information: Begin by filling out your personal information such as your full name, date of birth, address, contact details, and any other information requested on the form. This will help identify you and ensure accurate record-keeping.
4. Indicate your vaccination status: The form will typically ask you to indicate whether you have received the influenza vaccination for the 2015-2016 season. Check the appropriate box or provide the relevant information as requested. If you have not received the vaccination, you will need to continue to the next step.
5. Provide a reason for not receiving the vaccination: If you have chosen not to receive the influenza vaccination, you will generally be required to provide a reason for this decision. Common reasons may include medical contraindications, religious beliefs, or personal preferences. Be prepared to explain your reason accurately and concisely.
6. Sign and date the form: Once you have completed all the necessary sections of the form, carefully review your answers for accuracy. Sign and date the form in the designated area to authenticate your responses. If applicable, ensure any required witness signatures are obtained as well.

Who needs the 2015-2016 influenza vaccination attestation/declination?

1. Healthcare workers: Many healthcare institutions require their employees, including doctors, nurses, and other staff members, to complete the influenza vaccination attestation/declination. This helps ensure a safe working environment for both healthcare providers and patients.
2. Students and educational institutions: Some educational institutions, especially those in the healthcare field, may require students to complete the influenza vaccination attestation/declination. This is done to protect the health and safety of students, staff, and patients within the educational setting.
3. Employers and workplaces: Certain employers, particularly those in industries where close contact with others is common, may ask employees to complete the influenza vaccination attestation/declination. This is implemented to reduce the risk of widespread influenza outbreaks and promote a healthy work environment.

Overall, anyone who is required to provide proof of their influenza vaccination status or has opted to decline the vaccination may need to fill out the 2015-2016 influenza vaccination attestation/declination form. Specific requirements may vary depending on the organization or institution requesting the form.

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What is influenza vaccination attestationdeclination form?

The influenza vaccination attestation/declination form is a document that confirms whether an individual has received the influenza vaccine or has declined to receive it.

Who is required to file influenza vaccination attestationdeclination form?

Individuals who are required to file the influenza vaccination attestation/declination form include employees, students, healthcare workers, and visitors in certain settings.

How to fill out influenza vaccination attestationdeclination form?

To fill out the influenza vaccination attestation/declination form, one must provide their personal information, indicate whether they have received the influenza vaccine, sign and date the form.

What is the purpose of influenza vaccination attestationdeclination form?

The purpose of the influenza vaccination attestation/declination form is to track and record the vaccination status of individuals to prevent the spread of influenza.

What information must be reported on influenza vaccination attestationdeclination form?

The information reported on the influenza vaccination attestation/declination form typically includes name, date of birth, vaccination status, and signature.