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For office use only:HOWELL COUNTY HEALTH DEPARTMENT 20222023 INJECTABLE INFLUENZA CONSENT FORM PATIENT FIRST NAME:MI:STREET ADDRESS:PATIENT LAST NAME:DATE OF BIRTH:STATE:AGE:ZIP CODE:GENDER: ___ MALE

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The Howell County Health Department is a public health agency responsible for promoting and protecting the health of residents in Howell County. It provides services such as health education, disease prevention, and health-related programs.

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