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VACCINATION CONSENT FORM I have been offered or provided, whether accepted or not, a copy of the Vaccine Information Statement for the vaccine checked below and the Nevada County Community Health
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Start by reading the form carefully and ensuring that you understand all the information provided.
02
Fill in the required personal information such as your name, address, date of birth, and contact information.
03
Answer all the medical history questions accurately. If you're not sure about any specific details, consult your healthcare provider.
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Make sure to sign and date the form in the designated areas. Some forms may require a witness signature as well.
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If applicable, provide the necessary information regarding your insurance coverage or any specific requests related to the flu vaccine.
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Once you have completed filling out the form, review it again to ensure that all the information provided is accurate and legible.

Who needs the flu consent form 2012-13doc?

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Individuals who are planning on receiving the flu vaccine for the 2012-2013 flu season may need to fill out the flu consent form 2012-13doc.
02
This form is typically required for individuals of all ages, from children to adults.
03
It is important to check with the healthcare provider administering the flu vaccine to determine if this specific form is required or if there are any additional forms needed.
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Flu consent form2012-13doc is a document that allows individuals to consent to receiving the flu vaccine for the 2012-13 flu season.
Anyone who wants to receive the flu vaccine for the 2012-13 flu season is required to file the flu consent form2012-13doc.
To fill out the flu consent form2012-13doc, individuals need to provide their personal information, consent to receiving the flu vaccine, and sign the form.
The purpose of flu consent form2012-13doc is to ensure that individuals give their informed consent to receive the flu vaccine for the 2012-13 flu season.
The flu consent form2012-13doc must include personal information of the individual, consent to receive the flu vaccine, and signature.
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