Get the free Influenza Declination Form.doc

DALTON STATE COLLEGE CERTIFICATE OF IMMUNIZATION University System of Georgia PART A---To be completed by student Name (Last) (First) (Middle) Birthdate / / Social Security Number — Mailing Address

How to fill out influenza declination formdoc

1. First, gather all the necessary information required for filling out the influenza declination formdoc. This typically includes your personal details such as name, date of birth, contact information, and any relevant medical information.
2. Carefully read the instructions provided on the formdoc. Make sure you understand the purpose of the form and any specific requirements or guidelines for filling it out.
3. Begin by entering your personal information accurately and legibly. This may include your name, address, phone number, and email address.
4. Next, provide your date of birth and gender as requested on the formdoc. Double-check to ensure the accuracy of this information.
5. If the form requires any medical information or history, carefully fill out those sections. For example, you may be asked about any allergies, current medications, or past illnesses. Provide accurate and up-to-date information in these sections.
6. In the declination section of the formdoc, indicate your choice regarding the influenza vaccine. If you choose to decline the vaccine, make sure to read any additional instructions or requirements provided. Some forms may require an explanation or reason for declining the vaccination.
7. Carefully review the completed formdoc for any errors or missing information. Make sure all sections are filled out accurately and completely.
8. If the formdoc includes a signature or date field, sign and date the form as required. Some forms may also require additional signatures from a healthcare provider or witness.
9. Keep a copy of the completed formdoc for your records. If needed, submit the form to the appropriate authority or organization as instructed.

Who needs influenza declination formdoc:

1. The influenza declination formdoc may be required by healthcare facilities, employers, schools, or other organizations that have a policy or requirement for influenza vaccination.
2. Individuals who choose to decline the influenza vaccine may be required to fill out this form to document their decision.
3. Certain individuals who are exempt from receiving the influenza vaccine due to medical reasons or religious beliefs may also need to fill out this form to provide necessary documentation.

Overall, it is important to follow the specific instructions provided with the influenza declination formdoc and to accurately and completely fill out the form in order to meet any requirements or obligations.

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