Get the free 2016-17 INFLUENZA VACCINATION DECLINATION FORM

B I received the vaccine elsewhere but I am unable to provide documentation from the provider. A declination is not necessary if you provide documentation from the provider. 2016-17 INFLUENZA VACCINATION DECLINATION FORM St. Vincent s Medical Center and the CDC have recommended that I receive influenza vaccination in order to protect myself my family my colleagues and the patients to whom I provide care or service. Influenza vaccination is recommended for me and all other healthcare workers...

How to fill out 2016-17 influenza vaccination declination

How to fill out 2016-17 influenza vaccination declination

1. Step 1: Obtain the 2016-17 influenza vaccination declination form from a healthcare provider or employer.
2. Step 2: Read the instructions provided on the form carefully.
3. Step 3: Fill in your personal information, including your full name, contact details, and date of birth.
4. Step 4: Indicate the reason for your declination, if necessary, by checking the appropriate box or providing a brief explanation.
5. Step 5: Sign and date the form to indicate your agreement with the declination.
6. Step 6: Return the completed form to the healthcare provider or employer as per their instructions.
7. Step 7: Keep a copy of the declination form for your records.

Who needs 2016-17 influenza vaccination declination?

1. Individuals who have already received the 2016-17 influenza vaccination are not required to fill out the declination form.
2. People who have medical conditions that contraindicate receiving the influenza vaccination should complete the declination form.
3. Others who may need to fill out the declination form include individuals with personal or religious beliefs that prevent them from receiving the vaccine.
4. Employers or organizations may also require their employees or members to complete the declination form if they choose not to be vaccinated.

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