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Influenza Vaccine Consent Form Shawnee County, Kansas Section 1: Information about person to RECEIVE vaccine (please print) NAME (Last) (First)(M.I.)DATE OF BIRTH month___ day___ year ___ AGE GENDERADDRESS

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Fill out your personal details such as name, date of birth, address, and contact information.

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Anyone who wishes to receive a flu shot or influenza flu vaccine and is required to provide consent can use the eForms.com consent form. This includes individuals of all ages, from children to adults.

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What is eformscom consent flu-shot-influenza flu?

Eformscom consent flu-shot-influenza flu is a form that allows individuals to consent to receiving the flu shot to prevent influenza.

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Individuals who wish to receive the flu shot as a preventive measure against influenza are required to file eformscom consent flu-shot-influenza flu.

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To fill out eformscom consent flu-shot-influenza flu, individuals should provide their personal information, consent to receiving the flu shot, and sign the form.

What is the purpose of eformscom consent flu-shot-influenza flu?

The purpose of eformscom consent flu-shot-influenza flu is to ensure that individuals consent to receiving the flu shot to protect themselves and others from influenza.

What information must be reported on eformscom consent flu-shot-influenza flu?

The information reported on eformscom consent flu-shot-influenza flu includes personal details of the individual, consent to receiving the flu shot, and signature.

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