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Community Vaccine ProviderReport of Influenza Vaccine Utilization
the northern way of caring Page 1 of 2Utilization of publicly funded influenza vaccine must be reported to BC CDC. Upon completion
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How to fill out flu shot form
How to fill out flu shot form
01
Fill out personal information such as name, date of birth, address, and contact information.
02
Provide information about any allergies or previous adverse reactions to vaccines.
03
Indicate any existing medical conditions or medications being taken.
04
Answer questions about recent illness or exposure to illness.
05
Sign and date the form to acknowledge understanding and consent to receive the flu shot.
Who needs flu shot form?
01
Anyone who wishes to receive a flu shot at a healthcare facility or clinic will need to fill out a flu shot form.
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What is flu shot form?
Flu shot form is a document used to record receiving a vaccination for the flu.
Who is required to file flu shot form?
Individuals who have received a flu shot are required to file the flu shot form.
How to fill out flu shot form?
To fill out the flu shot form, you need to provide your personal information and details of the flu vaccination you received.
What is the purpose of flu shot form?
The purpose of the flu shot form is to keep a record of who has received the flu vaccination.
What information must be reported on flu shot form?
The flu shot form must include personal information of the individual receiving the vaccination and details of the flu shot received.
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