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Declination of Influenza Vaccination AND/ OR Administration Offsite Employee PhysicianVolunteer Contract Employee Licensed Independent PractitionerStudentVendorMy employer, Augusta Health, has recommended

How to fill out declination of influenza vaccination

How to fill out declination of influenza vaccination

1. Obtain the influenza vaccination form from your healthcare provider or vaccination center.
2. Fill out your personal information such as your name, date of birth, and contact information.
3. Provide your medical history, including any allergies or previous adverse reactions to vaccines.
4. Specify the type of influenza vaccine you are receiving and the date of vaccination.
5. Sign and date the declination form to indicate your consent or refusal to receive the influenza vaccination.
6. Return the completed form to your healthcare provider or vaccination center for their records.

Who needs declination of influenza vaccination?

1. Individuals who are recommended to receive the influenza vaccination include:
2. - People aged 6 months and older
3. - Pregnant women
4. - Individuals with chronic medical conditions
5. - Healthcare workers
6. - Caregivers of infants younger than 6 months
7. - People living in long-term care facilities
8. However, it is best to consult with your healthcare provider to determine if you specifically need the influenza vaccination based on your individual health status.

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What is declination of influenza vaccination?

Declination of influenza vaccination is when an individual chooses not to receive the influenza vaccine.

Who is required to file declination of influenza vaccination?

Individuals who are required to receive the influenza vaccination as per their workplace or organization policies may be required to file a declination if they choose not to get vaccinated.

How to fill out declination of influenza vaccination?

The process for filling out a declination of influenza vaccination may vary depending on the organization or workplace. Typically, it involves signing a form or providing a written statement indicating the decision to decline 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 vaccine, and to potentially assess vaccination coverage rates within a population.

What information must be reported on declination of influenza vaccination?

The information that may be reported on a declination of influenza vaccination form can include the individual's name, date of declination, reason for declining the vaccine, and signature.