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Print this pagePATIENT INFORMATION FORM23622 Calabasas Road, Suite 339 Calabasas, CA 91302 8182250117ALLERGIES Patient: SS# Last namesake of Birth: Age: First NameMIGender (circle)Headdress: CityStateFEMALEWork:
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Read the introduction and overview to understand the purpose of the fact sheet.
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Shingles Fact Sheet is designed to inform healthcare providers about the importance of vaccinations and preventive measures against shingles for their patients.
Healthcare providers, including doctors and clinics, are required to file the shingles fact sheet to inform their patients.
To fill out the shingles fact sheet, healthcare providers should include patient information, vaccination status, and relevant educational content.
The purpose is to educate patients about shingles, its risks, prevention methods, and the importance of vaccination.
The fact sheet must report on the risk factors for shingles, statistics on occurrence, recommended vaccinations, and preventable measures.
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