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20182019 Influenza Screening Form Name:Date of Birth:Age:Address:VACCINE OPTIONSRace:Insurance:65year (+) Injectable High Dose Vaccine I'm Prefilled High Dose Vaccine IM36mos (+)6mos 35mosFluzone

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How to fill out 2018-2019 influenza screening formdoc

01

To fill out the 2018-2019 influenza screening formdoc, follow these steps:

02

Obtain a copy of the formdoc from the appropriate authority or healthcare provider.

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Read the instructions and familiarize yourself with the form.

04

Provide personal information such as your name, date of birth, and contact details.

05

Answer the screening questions related to influenza symptoms and exposure.

06

Fill in any additional required information, such as medical history or recent travel.

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Review the completed form for accuracy and completeness.

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Sign and date the form if required.

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Submit the form as instructed, either online or in person.

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Keep a copy of the form for your records.

Who needs 2018-2019 influenza screening formdoc?

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The 2018-2019 influenza screening formdoc is typically required for individuals who:

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- are seeking a medical consultation or treatment related to influenza symptoms or exposure,

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- are enrolling in certain educational or childcare programs that require vaccination records,

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- are participating in research studies or clinical trials focused on influenza,

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- are traveling to regions with a high prevalence of influenza, or

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- are employees or healthcare professionals working in healthcare facilities.

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What is influenza screening formdoc?

Influenza screening formdoc is a document used to collect information regarding individuals' flu symptoms and exposure history to assess the need for further medical evaluation or testing.

Who is required to file influenza screening formdoc?

Individuals who exhibit flu-like symptoms or have been exposed to influenza are generally required to file the influenza screening formdoc.

How to fill out influenza screening formdoc?

To fill out the influenza screening formdoc, provide your personal information, details about your symptoms, exposure history, and any previous vaccinations, ensuring all sections are completed accurately.

What is the purpose of influenza screening formdoc?

The purpose of the influenza screening formdoc is to help healthcare providers evaluate the risk of influenza in individuals and determine the appropriate course of action, including testing and treatment.

What information must be reported on influenza screening formdoc?

Information that must be reported includes personal identification details, symptoms experienced, recent exposure to confirmed flu cases, vaccination status, and any underlying health conditions.

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