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20172018 Influenza Declination Statement I understand that immunization against influenza is an important patient safety issue and is supported by the Centers for Disease Control and Prevention (CDC),

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What is influenza declination statement?

The influenza declination statement is a form that allows individuals to indicate that they have chosen to decline receiving the influenza vaccine.

Who is required to file influenza declination statement?

Typically, healthcare workers and employees in certain industries are required to file an influenza declination statement if they choose not to receive the influenza vaccine.

How to fill out influenza declination statement?

The influenza declination statement can usually be filled out online or on a paper form provided by the employer or healthcare facility.

What is the purpose of influenza declination statement?

The purpose of the influenza declination statement is to track who has chosen not to receive the influenza vaccine for various reporting and compliance purposes.

What information must be reported on influenza declination statement?

The information typically reported on an influenza declination statement includes the individual's name, contact information, reason for declining the vaccine, and any relevant medical information.

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