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Flu Assessment Screening and Consent Form Camp. Bill Insurance CK / Cash / CC CK / Cash / CC First name: Last name: Age: SS # Date of birth: Gender: Race: Hispanic or Bonhomie address: City: State:
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To fill out the flu assessment screening, follow these steps:
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Read the questions carefully and make sure you understand what is being asked.
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Provide accurate and honest responses to each question.
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If a question requires a specific measurement or value, make sure to have that information handy.
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Take your time to answer each question thoroughly and to the best of your knowledge.
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If you are unsure about a question, it is better to provide a cautious response rather than guessing.
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Double-check your answers before submitting the screening form.
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If you have any concerns or questions while filling out the screening, seek assistance from a healthcare professional.
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Once you have completed all the questions, submit the flu assessment screening form as instructed.

Who needs flu assessment screening and?

01
Flu assessment screening is recommended for individuals who:
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- Experience flu-like symptoms such as fever, cough, sore throat, body aches, and fatigue.
03
- Have been in close contact with someone diagnosed with the flu.
04
- Have a weakened immune system.
05
- Are at a higher risk of developing complications from the flu, such as young children, older adults, pregnant women, and individuals with chronic medical conditions.
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- Have not received a flu vaccine and want to assess their risk of having the flu.
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If you fall into any of these categories, it is advisable to undergo flu assessment screening to determine appropriate care and treatment.
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Flu assessment screening is a tool used to determine if an individual has symptoms of the flu virus.
Healthcare providers and facilities are required to conduct and file flu assessment screenings.
Flu assessment screenings can be filled out by asking individuals about their symptoms and recent exposure to the flu virus.
The purpose of flu assessment screenings is to identify and track the spread of the flu virus.
Information such as symptoms, exposure to the flu virus, and date of assessment must be reported on flu assessment screenings.
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