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Name: DOB: / / The main reason(s) for visit: Drug allergies:History of: Recurrent infections? (sinusitis, bronchitis, pneumonia, ear infections)Most recent flu shot: Nasal polyps? Adverse reactions
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To fill out flu facts flu vaccine, follow these steps:
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Gather all the necessary information such as your personal details, medical history, and current health condition.
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Ensure that you have all the required documents, such as your ID or insurance information.
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Choose a healthcare provider or vaccination center where you can receive the flu vaccine.
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Contact the chosen healthcare provider or vaccination center to schedule an appointment.
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Arrive at the appointment on time and bring all the necessary documents.
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Follow the instructions given by the healthcare provider or vaccination center staff.
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Review the filled-out form for any errors or missing information.
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Submit the form to the healthcare provider or vaccination center staff.
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Follow any additional instructions provided by the healthcare provider or vaccination center for post-vaccination care.
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Who needs flu facts flu vaccine?

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Flu facts flu vaccine is recommended for the following individuals:
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- Anyone above the age of 6 months.
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- Individuals with chronic health conditions such as asthma, diabetes, or heart disease.
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- Pregnant women.
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- Healthcare workers.
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- People living in long-term care facilities or nursing homes.
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- Caregivers or household contacts of individuals at high risk for flu complications.
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- Adults over the age of 65.
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- Children aged 6 months to 5 years.
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It is important to consult with a healthcare provider to determine if the flu vaccine is appropriate for your specific situation.
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