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Consent FormInfluenza Vaccine Consent Form Section 1: Information for Individuals receiving the 201516 Influenza Vaccine (please print) NAME (Last)(First)(M.I.)DATE OF BIRTH month___ day___ year ___ADDRESS

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How to fill out immunisationaustralian government department of

01

Step 1: Obtain an immunisation form from the Australian Government Department of Health.

02

Step 2: Fill in your personal details, such as your name, date of birth, and contact information.

03

Step 3: Provide your healthcare provider's details, including their name and contact information.

04

Step 4: Indicate your vaccination history by providing the dates and names of vaccines received.

05

Step 5: If applicable, declare any medical exemptions or contraindications to vaccination.

06

Step 6: Sign and date the form.

07

Step 7: Submit the completed form to the relevant authorities or your healthcare provider.

Who needs immunisationaustralian government department of?

01

Immunisation is recommended for everyone in Australia, including both children and adults.

02

It is especially important for infants, as they are more susceptible to vaccine-preventable diseases.

03

Certain groups, such as healthcare workers, teachers, and people with specific medical conditions, may have additional vaccination requirements.

04

It is recommended to consult with your healthcare provider or refer to the Australian Government Department of Health guidelines to determine specific vaccination needs.

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What is immunisationaustralian government department of?

The Department of Health

Who is required to file immunisationaustralian government department of?

Healthcare providers and parents/guardians of children

How to fill out immunisationaustralian government department of?

By submitting the required immunisation records electronically or through a designated portal

What is the purpose of immunisationaustralian government department of?

To track and monitor immunisation rates to prevent the spread of communicable diseases

What information must be reported on immunisationaustralian government department of?

Details of immunisations given, dates, and patient information

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