Get the free 2012-13 School Based Influenza Vaccine Consent Form ... - forsyth k12 ga

201213 School Based Influenza Vaccine Consent Form Forsyth County Health Department Section 1: Information about Student to Receive Influenza Vaccine (please print) STUDENTS NAME (Last) (First) (M.I.)

How to fill out 2012-13 school based influenza

1. To fill out the 2012-13 school based influenza form, start by obtaining a copy of the form from your school or local health department.
2. Carefully read all the instructions and information provided on the form to ensure you understand what is required.
3. Begin by providing your personal details, such as your full name, date of birth, and contact information. This helps in accurately identifying the individual who is filling out the form.
4. Next, you may be asked to provide information about your previous vaccination history. This could include the dates of any flu shots received in the past and any known allergies or reactions to vaccines.
5. The form may also require details about your current health status. This could include questions about any pre-existing medical conditions, ongoing medications, or recent illnesses.
6. If applicable, you may also need to indicate if you have been in close contact with someone who has been diagnosed with influenza or any other contagious illness.
7. Additionally, the form might seek information regarding your insurance coverage or payment preferences for the vaccination.
8. Remember to review your completed form for accuracy and ensure all fields are properly filled out.
9. Finally, submit the form as instructed, either by mailing it to the designated address, delivering it to your school or health department, or following any other specified submission process.

Anyone who is required to receive the 2012-13 school based influenza vaccine needs this form. This usually includes students attending schools that offer influenza vaccinations as a preventive measure, their parents or legal guardians, and even school staff or employees. The form helps gather essential information about individuals receiving the vaccine, ensuring accurate and efficient administration and monitoring of the vaccination program.

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What is 13 school based influenza?

13 school based influenza refers to the reporting of influenza cases that occur within school settings.

Who is required to file 13 school based influenza?

School administrators or health officials are required to file 13 school based influenza.

How to fill out 13 school based influenza?

To fill out 13 school based influenza, one must gather information on confirmed influenza cases within schools and submit the report to the appropriate health agency.

What is the purpose of 13 school based influenza?

The purpose of 13 school based influenza is to track and monitor influenza cases within school settings to help prevent outbreaks and protect student health.

What information must be reported on 13 school based influenza?

Information such as number of confirmed cases, school names, dates of occurrence, and any preventative measures taken must be reported on 13 school based influenza.