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Influenza PreScreening Questionnaire Section 1: Information about Vaccine participant (please print) First Name:Surname:Date of Birth:Contact Number:Section 2: Screening for Vaccine Eligibility (please

How to fill out influenza pre-screening questionnaire

How to fill out influenza pre-screening questionnaire

1. To fill out the influenza pre-screening questionnaire, follow these steps:
2. Start by obtaining the questionnaire form from a healthcare provider or online.
3. Read the instructions and questions carefully to understand what information is required.
4. Begin by providing basic personal details such as your name, age, gender, and contact information.
5. Answer the questions regarding your medical history, specifically focusing on any respiratory symptoms or illnesses you may have experienced recently.
6. Be honest and accurate while filling out the questionnaire to ensure the healthcare provider gets the necessary information.
7. If you are unsure about any question, seek clarification from a healthcare professional.
8. Complete all sections of the questionnaire thoroughly.
9. Once finished, review your answers to ensure accuracy.
10. Submit the completed questionnaire to the designated healthcare provider or follow the given instructions for online submission.
11. Keep a copy of the filled questionnaire for your records.

Who needs influenza pre-screening questionnaire?

1. The influenza pre-screening questionnaire is needed by individuals who are seeking medical attention or healthcare services related to influenza.
2. This questionnaire helps healthcare providers assess the likelihood of influenza infection and determine appropriate treatment or preventive measures.
3. Anyone experiencing flu-like symptoms, seeking influenza vaccination, or requiring medical clearance for certain activities may be asked to fill out this questionnaire.

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What is influenza pre-screening questionnaire?

The influenza pre-screening questionnaire is a tool used to assess individuals for symptoms and risk factors related to influenza prior to receiving treatment or participating in public health programs.

Who is required to file influenza pre-screening questionnaire?

Individuals who are seeking vaccination for influenza or participating in specific healthcare programs that require monitoring for influenza symptoms are typically required to file the influenza pre-screening questionnaire.

How to fill out influenza pre-screening questionnaire?

To fill out the influenza pre-screening questionnaire, individuals need to provide accurate information regarding their health status, symptoms, recent travel history, and exposure to others who may be ill. It is usually done through an online form or a physical paper questionnaire provided by a healthcare provider.

What is the purpose of influenza pre-screening questionnaire?

The purpose of the influenza pre-screening questionnaire is to identify individuals who may be at higher risk for influenza infection, ensure appropriate care and vaccination, and prevent the spread of influenza in the community.

What information must be reported on influenza pre-screening questionnaire?

Information that must be reported typically includes personal identification details, vaccination history, current symptoms, underlying health conditions, recent travel, and contact with known influenza cases.