Get the free Flu Declination Form

Influenza Vaccine DECLINATION Statement 20132014 Flu Season I am aware of the following facts: Influenza is a serious respiratory disease; on average, 36,000 Americans die every year from influenza

How to fill out flu declination form

How to fill out flu declination form:

1. Obtain the form: You can typically get a flu declination form from your employer or healthcare provider. Contact them to request a copy of the form if it is not already provided to you.
2. Read the instructions: Carefully go through the instructions provided on the form. This will help you understand the purpose of the form and the information you need to provide.
3. Personal information: Fill in your personal details such as your full name, date of birth, and contact information in the designated sections of the form. Make sure to double-check the accuracy of the information before proceeding.
4. Tick the appropriate box: The form may have options for different categories, such as "I have received the flu vaccine" or "I decline the flu vaccine." Select the option that accurately represents your decision.
5. Sign and date: Once you have completed filling in the required information and made your choice, sign and date the form. This confirms your decision and serves as your consent or refusal.
6. Return the form: After filling out the form, submit it to the appropriate recipient. This could be your employer's HR department, your healthcare provider, or any other designated contact specified on the form.

Who needs flu declination form:

1. Employees: Individuals who work in organizations or companies that require their employees to receive the flu vaccine may need to fill out a flu declination form if they choose not to get vaccinated.
2. Healthcare workers: Healthcare professionals, including doctors, nurses, and support staff, often need to fill out a flu declination form if they opt not to receive the flu vaccine.
3. Students: Educational institutions may require students, particularly those in healthcare or other high-risk fields, to provide a flu declination form if they choose not to be vaccinated.
4. General public: In some cases, flu declination forms are made available to the general public who want to decline the flu vaccine for various reasons. This could be offered at community health centers or by healthcare providers upon request.

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What is flu declination form?

Flu declination form is a form used to indicate that an individual is choosing not to receive the flu vaccine.

Who is required to file flu declination form?

Employees who are choosing not to receive the flu vaccine are required to file flu declination form.

How to fill out flu declination form?

To fill out the flu declination form, individuals need to provide their personal information and indicate that they are declining the flu vaccine.

What is the purpose of flu declination form?

The purpose of the flu declination form is to track and document individuals who are choosing not to receive the flu vaccine for various reasons.

What information must be reported on flu declination form?

The flu declination form typically requires information such as the individual's name, contact information, reason for declining the flu vaccine, and signature.