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62 E Mill Road Long Valley NJ 07853 Tel: 9088769000 Fax: 9088765578 info longvalleypharmacy.com Date of Birth: Patient Name: Nursing Facility Name: (mm) (dd) (yr) Screening Questionnaire for Inactivated
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Start by gathering all the necessary information. This includes personal details such as your full name, date of birth, and contact information.
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Read through the consent form carefully. Understand the purpose of the form and the information it is requesting.
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Fill in your personal information accurately and legibly. Make sure to double-check and ensure there are no mistakes.
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Look for any specific sections or questions related to the flu vaccine. These may include questions about your medical history, allergies, or any previous adverse reactions to vaccines.
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Individuals who are planning to receive the flu vaccine need flu only consent-lv. This form ensures that they have read and understood the information related to the vaccine and have given their consent for its administration.
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Flu only consent-lv is a form that allows individuals to consent to receiving flu vaccination only.
Individuals who wish to receive flu vaccination only are required to file flu only consent-lv.
Flu only consent-lv can be filled out by providing personal information, signing the form, and indicating consent for flu vaccination only.
The purpose of flu only consent-lv is to ensure individuals receive flu vaccination only and to document their consent.
Information such as name, date of birth, contact information, medical history, and consent for flu vaccination only must be reported on flu only consent-lv.
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