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BETHLEHEM HEALTH BUREAU Seasonal Influenza Vaccination Consent Form Name: Date of Birth: Sex: M F Address: Telephone: Zip Code: Please circle YES or NO to the questions below: 1. Does the patient

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What is seasonal influenza vaccination consent?

Seasonal influenza vaccination consent is a form that allows individuals to give permission for receiving the seasonal flu vaccine.

Who is required to file seasonal influenza vaccination consent?

Individuals who wish to receive the seasonal influenza vaccine are required to file the consent form.

How to fill out seasonal influenza vaccination consent?

To fill out the seasonal influenza vaccination consent, individuals must provide their personal information, medical history, and consent for receiving the vaccine.

What is the purpose of seasonal influenza vaccination consent?

The purpose of seasonal influenza vaccination consent is to ensure that individuals understand the risks and benefits of receiving the vaccine and give informed consent for vaccination.

What information must be reported on seasonal influenza vaccination consent?

Seasonal influenza vaccination consent must include personal information, medical history, consent for vaccination, and any known allergies or medical conditions.

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