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Passport Health is the Nations largest provider of travel medical & immunizations services. www.passporthealthusa.com 18884997277INFLUENZA IMMUNIZATION SCREENING FORM Please complete & sign this page
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How to fill out influenza screening form
How to fill out influenza screening form
01
To fill out the influenza screening form, follow these steps:
02
Start by entering your personal information such as name, date of birth, and contact details.
03
Next, provide details about your medical history, including any pre-existing conditions or allergies.
04
Answer the screening questions regarding your current symptoms, such as fever, cough, sore throat, and body aches.
05
If you have traveled recently, mention the countries you visited and the duration of your stay.
06
Specify if you have been in close contact with anyone diagnosed with influenza or COVID-19.
07
Finally, sign and date the form to complete the process.
Who needs influenza screening form?
01
Anyone who wants to assess their risk of influenza or is seeking medical advice regarding flu-like symptoms should fill out the influenza screening form.
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What is influenza screening form?
Influenza screening form is a document used to assess individuals for symptoms of the flu.
Who is required to file influenza screening form?
Employees, visitors, or anyone entering a healthcare facility may be required to fill out an influenza screening form.
How to fill out influenza screening form?
Influenza screening forms can typically be filled out online or in person by providing information about symptoms and recent exposure.
What is the purpose of influenza screening form?
The purpose of the influenza screening form is to prevent the spread of flu within healthcare settings by identifying and isolating sick individuals.
What information must be reported on influenza screening form?
Information such as symptoms, recent contact with sick individuals, and recent travel history may need to be reported on the influenza screening form.
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