Get the free HFHS Flu Medical Exemption Form - Early College
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Influenza Vaccine: Henry Ford Health System Medical Exemption Statement Date Name Employee MAN Work Location: System Human Resource Policy # 12.5.1: Documented Bona Fide Reasons: GuilianBarr Syndrome
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How to fill out hfhs flu medical exemption
How to fill out hfhs flu medical exemption:
01
Obtain the hfhs flu medical exemption form from the designated source.
02
Fill in your personal information accurately, including your name, date of birth, and contact information.
03
Provide your medical history related to flu vaccinations, including any past adverse reactions or medical conditions that may make vaccination risky.
04
Explain the specific reasons why you are seeking exemption from the flu vaccination. This may include allergies, prior adverse reactions, or religious beliefs.
05
Attach any supporting documentation, such as medical records or a letter from your religious leader, if required or applicable.
06
Review the completed form to ensure all information is correct and legible.
07
Sign and date the form as required.
08
Submit the completed hfhs flu medical exemption form to the appropriate authority or department.
Who needs hfhs flu medical exemption:
01
Individuals who have a documented history of severe allergic reactions to flu vaccines may need hfhs flu medical exemption.
02
Individuals with specific medical conditions or immunodeficiency that make receiving the flu vaccine potentially harmful may require hfhs flu medical exemption.
03
Some individuals with religious beliefs that prohibit the use of vaccines or specific vaccine ingredients may seek hfhs flu medical exemption to honor their religious beliefs.
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