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MENINGOCOCCAL VACCINE CONSENT FORM Information about person to be vaccinated (Please print) Last Name: First Name: (For office use only) Clinic: Hamlin County OFFS #128 300 4th St Age: Haiti, SD 57241
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How to fill out meningococcal vaccine consent form
How to fill out meningococcal vaccine consent form
01
Read the form instructions carefully.
02
Provide accurate personal information in the required fields.
03
Indicate the date of the vaccination.
04
Sign and date the form to acknowledge your consent for receiving the meningococcal vaccine.
05
If applicable, provide any additional information or medical history that may be relevant.
06
Submit the completed form to the healthcare provider or vaccination center.
07
Keep a copy of the filled out form for your records.
Who needs meningococcal vaccine consent form?
01
Individuals who are eligible and recommended to receive the meningococcal vaccine.
02
Minors may require parental or guardian consent to receive the vaccine.
03
People who are planning to travel to areas with high rates of meningococcal disease.
04
College students living in dormitories or other close-contact communities.
05
Individuals with certain medical conditions or immunodeficiencies.
06
Healthcare workers and laboratory personnel who may encounter the bacteria associated with meningococcal disease.
07
Others should consult with their healthcare provider to determine if they need the meningococcal vaccine.
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