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Influenza Vaccination Declination HealthSource Global Staffing has recommended that I receive the influenza vaccination in order to protect the patients I serve. I understand that because I work in

How to fill out influenza declination form

How to fill out influenza declination form:

1. Obtain the influenza declination form from your employer or healthcare provider. This form is usually distributed during the flu season to individuals who are eligible for the influenza vaccine but choose not to receive it.
2. Read the instructions carefully on the form. The form may require you to provide personal information such as your name, address, date of birth, and contact information.
3. Indicate your decision to decline the influenza vaccine by checking the appropriate box or providing a written statement. Be clear and concise in explaining your decision.
4. If required, provide a reason for declining the vaccine. Some forms may ask for an explanation, such as a medical condition, religious beliefs, or personal preferences. If you have a specific reason, state it in a respectful manner.
5. Sign and date the form to verify your decision. Some forms may require witnessing or additional signatures, so make sure to follow the provided instructions.
6. Return the completed form to the designated recipient. This could be your employer or healthcare provider, depending on who provided you with the form.

Who needs influenza declination form:

1. Employees who work in industries where the influenza vaccine is strongly recommended or mandated may need to fill out an influenza declination form. This can include healthcare workers, first responders, and workers in long-term care facilities.
2. Individuals who have medical contraindications to receiving the influenza vaccine, such as severe allergies or a compromised immune system, may need to complete a declination form to officially exempt themselves from the vaccination requirement.
3. Some employers or educational institutions may require all individuals, regardless of their occupation or health status, to complete an influenza declination form as part of their administrative procedures or to gather data on vaccine coverage rates.

Note: The specific requirements for needing an influenza declination form may vary depending on local regulations, workplace policies, and individual circumstances. It's important to consult with your employer or healthcare provider if you are unsure whether you need to fill out this form.

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What is influenza declination form?

Influenza declination form is a document that employees fill out to refuse receiving the influenza vaccine.

Who is required to file influenza declination form?

Employees who choose not to receive the influenza vaccine are required to file the influenza declination form.

How to fill out influenza declination form?

Employees can fill out the influenza declination form by providing their personal information and reason for refusing the influenza vaccine.

What is the purpose of influenza declination form?

The purpose of the influenza declination form is to document employees' decision to decline the influenza vaccine.

What information must be reported on influenza declination form?

The influenza declination form may require employees to provide their name, employee ID, department, reason for declination, and signature.