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Influenza Immunization Consent Form 2010-2011 The first section must be completed to receive a flu shot today. (PLEASE PRINT CLEARLY) Employer Eugene School District 4J First Name: Sex: ? M ? F Date
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How to fill out 4j flu consent form
How to fill out 4j flu consent form?
01
Gather all necessary information: Before starting to fill out the form, make sure you have all the required information at hand. This may include personal details such as name, address, date of birth, and contact information.
02
Read the instructions carefully: Take your time to read through the instructions provided on the form. Understand the purpose of the form and any specific requirements or guidelines mentioned.
03
Provide personal information: Begin by filling in your personal information accurately. This typically includes your full name, date of birth, address, phone number, and email address. Be sure to double-check the accuracy of this information before moving on.
04
Consent section: The flu consent form will likely include a section where you need to provide your consent for receiving the flu vaccine. Read through this section carefully and follow the given instructions to indicate your consent.
05
Medical history: Some consent forms may ask for your medical history or any existing health conditions. Fill in this section truthfully, providing any relevant details that may impact your ability to receive the flu vaccine.
06
Review and sign: Once you have filled in all the required information, review the form one more time to ensure everything is accurate and complete. Then, sign and date the form as instructed.
Who needs 4j flu consent form?
01
Students: The 4j flu consent form is typically required for students in the 4j school district who wish to receive the flu vaccine. This ensures that the administration of vaccines is done with the appropriate consent and medical information.
02
Parents/Guardians: If the student is a minor, their parents or legal guardians will need to fill out the 4j flu consent form on their behalf. It is important for parents/guardians to provide accurate information and indicate their consent for the vaccine administration.
03
School staff: In some cases, school staff members may also need to fill out the 4j flu consent form if they wish to receive the flu vaccine through the school's vaccination program. This ensures that the staff's medical information and consent are properly documented.
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What is 4j flu consent form?
4j flu consent form is a document used to obtain consent from individuals to receive flu vaccinations in the context of the 4j flu program.
Who is required to file 4j flu consent form?
All individuals who wish to receive flu vaccinations through the 4j flu program are required to file the 4j flu consent form.
How to fill out 4j flu consent form?
To fill out the 4j flu consent form, individuals need to provide their personal information, consent to receiving the flu vaccine, and sign the form.
What is the purpose of 4j flu consent form?
The purpose of the 4j flu consent form is to ensure that individuals are informed about and agree to receiving flu vaccinations as part of the 4j flu program.
What information must be reported on 4j flu consent form?
The 4j flu consent form typically requires information such as name, contact details, medical history, and consent for vaccination.
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