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FARGO CLASS PUBLIC HEALTH 1240 25th Street South Fargo, ND 581032367 Phone 701.241.1360 | Fax 701.298.6929FargoCassPublicHealth.influenza CONSENTLocation: Mass Clinic (60)Last NameFirst Name. I. Date

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How to fill out influenza consent

01

Obtain the blank influenza consent form from a healthcare provider or facility

02

Read and understand all the information provided on the consent form

03

Fill in all the necessary personal information such as name, date of birth, address, and contact details

04

Review the risks and benefits of getting the influenza vaccine as stated on the form

05

Sign and date the consent form to indicate your agreement to receive the influenza vaccine

Who needs influenza consent?

01

Anyone who wishes to receive the influenza vaccine, especially those in high-risk groups such as young children, elderly individuals, pregnant women, and individuals with chronic health conditions

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What is influenza consent?

Influenza consent is a form that allows individuals to give permission for receiving the influenza vaccine.

Who is required to file influenza consent?

Influenza consent is typically required for individuals who are under the age of 18 or those who are unable to make medical decisions on their own.

How to fill out influenza consent?

Influenza consent can be filled out by providing personal information, signing the form, and indicating consent for the influenza vaccine.

What is the purpose of influenza consent?

The purpose of influenza consent is to ensure that individuals are aware of and approve of receiving the influenza vaccine.

What information must be reported on influenza consent?

Influenza consent may require information such as name, date of birth, contact information, medical history, and consent decision.

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