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CALIFORNIA IMMUNIZATION REGISTRY REGION IV REFUSAL/INFORMATION REQUEST FORM PLEASE RETURN THIS COMPLETED FORM Mail: San Joaquin County Public Health Services Fax: 209-468-8361 / ATTN: Immunization
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Specify the date and time of the ride refusal. It's important to provide accurate details to properly document the incident.
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Clearly state the reason for your ride refusal. Whether it's due to safety concerns, personal preference, or any other valid reason, explain it clearly and concisely.
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If required, provide additional supporting information or documentation. This may include witness statements, medical records, or any other relevant evidence that supports your reason for refusing the ride.
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Who needs ride refusal form-english-final-102413:
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Individuals who have refused a ride for any valid reason.
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Taxi drivers, Uber or Lyft drivers, or any other transportation service providers who encountered a situation where a passenger refused a ride.
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Companies or organizations that require documentation of ride refusals for record-keeping or legal purposes.
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