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201920 School Based Influenza Vaccine Consent Form Forsyth County Health Department Section 1: Information about Student to Receive Influenza Vaccine (please print) STUDENTS NAME (Last)(First)(M.I.)STUDENTS

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How to fill out 2019-20 school based influenza

01

To fill out the 2019-20 school based influenza form, follow these steps:

02

Obtain the form from the school or healthcare provider.

03

Read the instructions on the form carefully.

04

Fill in the required personal and medical information accurately.

05

Provide any relevant medical history or conditions, if requested.

06

Follow the guidelines for indicating immunization preferences or consent.

07

Sign and date the form in the designated spaces.

08

Submit the completed form to the school or healthcare provider.

Who needs 2019-20 school based influenza?

01

The 2019-20 school based influenza form is necessary for:

02

- All students attending school during the academic year 2019-20.

03

- Teachers, staff, and other school personnel.

04

- Parents or guardians of students to provide consent for immunization.

05

- Individuals who wish to receive the influenza vaccine at school.

06

- Any other individuals recommended by healthcare professionals or local authorities.

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What is 20 school based influenza?

20 school based influenza is a report that tracks influenza cases within schools.

Who is required to file 20 school based influenza?

School administrators or health officials are required to file 20 school based influenza.

How to fill out 20 school based influenza?

To fill out 20 school based influenza, you need to provide information on the number of influenza cases in each school.

What is the purpose of 20 school based influenza?

The purpose of 20 school based influenza is to monitor and track influenza cases within schools to prevent outbreaks.

What information must be reported on 20 school based influenza?

Information such as the number of influenza cases, schools affected, and any preventative measures taken must be reported on 20 school based influenza.

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