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Annual Influenza Vaccine Consent Form2021/2022Section 1: Patient Information (please print)Patient Name (Last)(First) (M.I.) Patient DOB:Parent/Guardian Name (Last)(First) (M.I.) Patient Age: Pinon
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The ghcdsorgwp-contentuploadsannual influenza vaccine consent is a form allowing individuals to consent to receiving the annual influenza vaccine.
Individuals who wish to receive the annual influenza vaccine are required to fill out the ghcdsorgwp-contentuploadsannual influenza vaccine consent form.
To fill out the ghcdsorgwp-contentuploadsannual influenza vaccine consent, individuals must provide their personal information and sign the consent form.
The purpose of the ghcdsorgwp-contentuploadsannual influenza vaccine consent is to obtain consent from individuals to receive the annual influenza vaccine.
The ghcdsorgwp-contentuploadsannual influenza vaccine consent form must include personal information of the individual, consent signature, and any relevant medical history.
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