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20182019 SEASONAL INFLUENZA AND PNEUMOCOCCAL CONSENT FORM Region: PRAIRIE MOUNTAIN Healthline Location: DAUPHIN CLINIC PHARMACYClient Information SurnameGiven NamesAddressCity/Townhouse Phone Date
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01
Obtain the mb health flu-pneumo consent form from the designated authority.
02
Read and understand the consent form thoroughly.
03
Fill in your personal information, including your name, date of birth, address, and contact details.
04
Provide any relevant medical information, such as allergies or previous vaccinations.
05
Sign and date the consent form.
06
If applicable, have a witness sign and provide their contact information as well.
07
Submit the completed consent form to the designated authority.

Who needs mb health flu-pneumo consent?

01
Anyone who wishes to receive the flu or pneumonia vaccination from mb health may need to fill out the mb health flu-pneumo consent form.
02
It is particularly important for individuals with certain medical conditions, such as compromised immune systems or respiratory issues, to provide consent and receive the vaccination.
03
Additionally, healthcare providers may require consent forms from their patients to ensure proper documentation and liability coverage.
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The MB Health Flu-Pneumo Consent is a form that allows individuals to provide consent for receiving flu and pneumococcal vaccinations for the purpose of public health.
Any individual who wishes to receive flu and pneumococcal vaccinations in Manitoba must file the MB Health Flu-Pneumo Consent form.
To fill out the MB Health Flu-Pneumo Consent form, individuals must provide their personal information, indicate their consent for receiving the vaccinations, and sign the form.
The purpose of the MB Health Flu-Pneumo Consent form is to ensure that individuals understand and consent to receiving flu and pneumococcal vaccinations for public health reasons.
The MB Health Flu-Pneumo Consent form requires individuals to provide personal information such as name, date of birth, contact information, and consent for the vaccinations.
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