Get the free 201213 School Based Influenza Vaccine Consent Form Dawson County Health Department S...

2012 – 13 School Based Influenza Vaccine Consent Form Dawson County Health Department Section 1: Information about Student to Receive Influenza Vaccine (please print) STUDENT S NAME (Last) STUDENT

How to fill out 201213 school based influenza

How to fill out 201213 school based influenza:

1. Obtain the 201213 school based influenza form from the school administration or health department.
2. Fill out the personal information section, including name, date of birth, and contact information.
3. Provide information about the school, such as the name, address, and contact details.
4. Answer the questions regarding symptoms of influenza, such as fever, cough, sore throat, and body aches. If any symptoms are present, indicate the severity and duration.
5. Indicate whether the student has received a flu shot and provide the date of vaccination if applicable.
6. If the student has been diagnosed with influenza, provide the date of diagnosis and any prescribed medications.
7. Fill out any additional information required, such as medical history, previous influenza vaccinations, and allergies.
8. Review the form for completeness and accuracy before submitting it to the school or health department.

Who needs 201213 school based influenza:

1. Students: All students attending the school should complete the 201213 school based influenza form. This helps track and monitor the spread of influenza within the school community.
2. Parents/Guardians: Parents or guardians of students are responsible for filling out the form on behalf of their child. It is important for parents to accurately provide information about their child's health status to ensure proper care and prevention measures can be implemented.
3. School Administration/Health Department: The school administration and health department use the collected information to assess the prevalence of influenza within the school, implement preventive measures, and provide appropriate medical support to affected students. The data helps in planning and responding to influenza outbreaks effectively.

For pdfFiller’s FAQs

What is 201213 school based influenza?

201213 school based influenza is a reporting requirement for schools to track and report cases of influenza among students and staff.

Who is required to file 201213 school based influenza?

All schools, including public and private, are required to file 201213 school based influenza.

How to fill out 201213 school based influenza?

Schools can fill out the 201213 school based influenza form online or submit a physical copy to the relevant health department.

What is the purpose of 201213 school based influenza?

The purpose of 201213 school based influenza is to monitor and track influenza cases in school settings to prevent outbreaks and protect the health of students and staff.

What information must be reported on 201213 school based influenza?

Schools must report the number of influenza cases among students and staff, as well as any preventive measures taken to control the spread of the virus.

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