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Influenza Immunization Consent Form Putnam County Department of Health Name (please print)Date of Birthdate of Flu Clinic 9/29/15 ___ Address City State Zip ___ Grade/Teacher Sex Phone (where parent
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Anyone who requires influenza and pneumococcal immunization as per the guidelines set by www.health.ny.gov may need to fill out the form doh-4156influenzapneumococcal immunization. The exact eligibility criteria can be found on the website or by consulting a healthcare professional.
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wwwhealthnygov forms doh-4156influenzapneumococcal immunization is a form used to report influenza and pneumococcal immunization data in New York.
Healthcare providers in New York are required to file wwwhealthnygov forms doh-4156influenzapneumococcal immunization.
To fill out wwwhealthnygov forms doh-4156influenzapneumococcal immunization, healthcare providers need to input relevant immunization data for influenza and pneumococcal vaccines administered.
The purpose of wwwhealthnygov forms doh-4156influenzapneumococcal immunization is to track and monitor influenza and pneumococcal immunization rates in New York.
On wwwhealthnygov forms doh-4156influenzapneumococcal immunization, healthcare providers must report the number of influenza and pneumococcal vaccines administered.
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