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KENT COUNTY HEALTH DEPARTMENT LELAND D. SPENCER, M.D., M.P.H., HEALTH OFFICER 125 S. Lynchburg Street, Chesterton, Maryland 21620 Phone: (410) 778-1350 COUNTY OF KENT STATE OF MARYLAND Please Print
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How to fill out the 2014-2015 flu vaccine form:

01
Start by reading the form carefully and familiarizing yourself with the sections and questions.
02
Begin by providing your personal information, such as your full name, date of birth, and contact details. This information is essential for identification purposes.
03
Move on to the medical history section, where you will be asked about any pre-existing medical conditions or allergies. Provide accurate information as it can help determine your eligibility for the flu vaccine.
04
The form may also ask about any previous adverse reactions to vaccines or medications. If you have experienced any in the past, it is important to mention them.
05
Next, indicate your current medications or any ongoing treatment you are undergoing. This information helps healthcare professionals determine the appropriateness of the vaccine for you.
06
In some cases, the form may inquire about potential pregnancy or breastfeeding. Respond accurately and truthfully, as specific vaccines may have different recommendations for pregnant or breastfeeding individuals.
07
Finally, if there is a consent section, read it carefully and provide your signature or initials, indicating your agreement with the terms and conditions.
08
Review your completed form to ensure all the necessary information has been provided accurately. If you are unsure about any questions, seek clarification from a healthcare professional.

Who needs the 2014-2015 flu vaccine form:

01
Individuals who are eligible for receiving the flu vaccine during the 2014-2015 flu season.
02
Those who are at a higher risk of developing complications from influenza, such as young children, pregnant women, older adults, and individuals with chronic health conditions.
03
Any individual wishing to receive the flu vaccine may be required to fill out the form for administrative and medical record purposes. It helps healthcare providers ensure that the vaccine is safe and appropriate for the recipient.
Remember, it is always best to consult with a healthcare professional or visit a vaccination clinic to get accurate and up-to-date information on the flu vaccine and the associated forms for the specific year.
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The flu vaccine form is a document used to record the administration of the flu vaccine.
Healthcare providers, employers, and individuals who administer the flu vaccine are required to file the flu vaccine form.
The flu vaccine form can be filled out by entering the necessary information such as the recipient's name, date of vaccination, vaccine manufacturer, lot number, and administering healthcare provider.
The purpose of the flu vaccine form is to track and monitor flu vaccine administration, ensure accurate reporting, and facilitate public health efforts to prevent the spread of influenza.
The flu vaccine form must include the recipient's name, date of vaccination, vaccine manufacturer, lot number, and administering healthcare provider.
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