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Declination of Influenza Vaccination My employer or affiliated health facility, has recommended that I receive influenza vaccination in order to protect myself and the patients I serve. I acknowledge

How to fill out declination of influenza vaccination

How to fill out declination of influenza vaccination:

1. Obtain the declination form from your healthcare provider, employer, or educational institution. It may also be available online.
2. Fill in your personal information accurately, including your full name, date of birth, and contact details.
3. Provide information on your healthcare provider, including their name, address, and contact information.
4. Indicate the reason for declining the influenza vaccination. This may include medical contraindications, religious beliefs, or personal preferences.
5. Sign and date the declination form. Make sure to read and understand any accompanying statements or disclaimers.

Who needs declination of influenza vaccination:

1. Individuals who have medical contraindications to receiving the influenza vaccination, such as severe allergies or specific health conditions.
2. Those who hold strong religious beliefs that prohibit the use of vaccines.
3. Individuals who have personal preferences against receiving the influenza vaccination, but understand the risks and consequences of not being vaccinated.

It is important to note that the eligibility and requirements for a declination of influenza vaccination may vary depending on the specific healthcare provider, employer, or educational institution. It is advisable to consult with the respective authority to ensure compliance with their guidelines.

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What is declination of influenza vaccination?

Declination of influenza vaccination is the process of formally refusing to receive the influenza vaccine.

Who is required to file declination of influenza vaccination?

Employees who choose not to receive the influenza vaccine are required to file a declination of influenza vaccination.

How to fill out declination of influenza vaccination?

To fill out declination of influenza vaccination, employees typically need to provide their name, signature, and the reason for declining the vaccine.

What is the purpose of declination of influenza vaccination?

The purpose of declination of influenza vaccination is to document an individual's decision to not receive the influenza vaccine.

What information must be reported on declination of influenza vaccination?

Information such as the employee's name, signature, and reason for declining the vaccine must be reported on the declination of influenza vaccination form.