CA Kaiser Permanente Influenza Vaccination Declination Form 2016 free printable template
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Northern California RETURN OR FAX TO EHS Fremont: 5102485111 San Leandro: 5104544561 Name Department Medical Record # Employee Number # Influenza Vaccine Form 20162017 I had the 20162017 Flu Vaccine
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How to fill out CA Kaiser Permanente Influenza Vaccination Declination
How to fill out CA Kaiser Permanente Influenza Vaccination Declination Form
01
Obtain the CA Kaiser Permanente Influenza Vaccination Declination Form from your healthcare provider or the Kaiser Permanente website.
02
Fill out your personal information at the top section, including your name, address, and contact details.
03
Read the information about the influenza vaccine provided on the form carefully.
04
Indicate your reason for declining the vaccination by selecting one of the available options or writing your own reason in the designated area.
05
Sign and date the form to confirm your decision.
06
Submit the completed form to your healthcare provider or designated office as instructed.
Who needs CA Kaiser Permanente Influenza Vaccination Declination Form?
01
Individuals who choose not to receive the influenza vaccination while participating in a Kaiser Permanente health program or those required by their employer for compliance.
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People Also Ask about
Is the flu shot inflammatory?
Common side effects from the flu shot include: Soreness, redness, and/or swelling from the shot.
What are the components of a vaccine?
Vaccines contain an active component (the antigen) which induces the immune response. They may also contain additional components such as preservatives, additives, adjuvants and traces of other components.
What exactly is in the flu vaccine?
This vaccine is made with an adjuvant (an ingredient that helps create a stronger immune response). An egg-based live attenuated flu nasal spray vaccine (FluMist Quadrivalent) made with attenuated (weakened) live flu viruses, which is approved for use in people 2 years through 49 years.
What are the side effects of the Kaiser flu shot?
Soreness, redness, and swelling where the shot is given, fever, muscle aches, and headache can happen after influenza vaccination. There may be a very small increased risk of Guillain-Barré Syndrome (GBS) after inactivated influenza vaccine (the flu shot).
How long does a flu vaccine protect you?
The flu shot can last for up to six months, though it is most effective for the first three months.
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What is CA Kaiser Permanente Influenza Vaccination Declination Form?
The CA Kaiser Permanente Influenza Vaccination Declination Form is a document that allows individuals to formally decline receiving the influenza vaccine while acknowledging the risks of not getting vaccinated.
Who is required to file CA Kaiser Permanente Influenza Vaccination Declination Form?
Individuals, particularly healthcare workers and staff in certain healthcare settings, who choose not to receive the influenza vaccine are required to file this form.
How to fill out CA Kaiser Permanente Influenza Vaccination Declination Form?
To fill out the form, individuals must provide personal information, including their name and contact details, indicate their decision to decline the vaccine, and sign the form to confirm their understanding of the implications.
What is the purpose of CA Kaiser Permanente Influenza Vaccination Declination Form?
The purpose of the form is to document an individual's decision to decline the influenza vaccine, ensuring that they are informed about the associated risks and the importance of vaccination.
What information must be reported on CA Kaiser Permanente Influenza Vaccination Declination Form?
The form requires personal identification information, a clear statement of declination, and a signature to acknowledge understanding of the risks involved with not being vaccinated.
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