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Vaccination Outreach Registration/Screening Form: AFC Flu Clinic Ottawa County Department of Public Health Patient name DOB: / / Last(Legal) FirstMiddleAny previous names: Gender: Address: Streetcar

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What is vaccination outreach registrationscreening form?

The vaccination outreach registrationscreening form is a form used to register individuals for vaccination outreach programs and screenings.

Who is required to file vaccination outreach registrationscreening form?

Healthcare providers and organizations conducting vaccination outreach programs are required to file the registrationscreening form.

How to fill out vaccination outreach registrationscreening form?

To fill out the registrationscreening form, individuals need to provide personal information, vaccination history, and consent for screening and vaccination.

What is the purpose of vaccination outreach registrationscreening form?

The purpose of the registrationscreening form is to ensure accurate record keeping and efficient coordination of vaccination outreach programs.

What information must be reported on vaccination outreach registrationscreening form?

Information such as name, date of birth, contact details, vaccination history, and consent for screening and vaccination must be reported on the registrationscreening form.

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