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20202021 SarsCov2 COVID-19 Vaccine Consent Form Hillsdale Hospital Hillsdale, Michigan Information about Individual to Receive Vaccine (Please Print) NAME (Last)D.L. #(First)DATE OF BIRTH:Month:(M.I.)
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Gather all the necessary information about the department or agency, such as its name, address, phone number, and website.
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Department or agency employed refers to the specific government department or agency where the individual is currently employed.
Individuals who are required to file department or agency employed include government employees and officials.
Department or agency employed can be filled out by providing the name of the government department or agency where the individual works.
The purpose of department or agency employed is to provide transparency and ensure potential conflicts of interest are disclosed.
The information reported on department or agency employed typically includes the name of the department or agency, position held, and any relevant details.
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