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CONFIDENTIALAttachment 1 HAWAII HEALTH SYSTEMS CORPORATION (HHSC)COVID-19 VACCINATION ATTESTATION FORM LAST NAME:FIRST NAME:DEPARTMENT:POSITION:Pursuant to the Mandatory COVID-19 Vaccination for Current

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How to fill out vaccination attestation form htfaen

01

Obtain a copy of the vaccination attestation form htfaen from a healthcare provider or government agency.

02

Fill out your personal information accurately, including your full name, date of birth, and contact information.

03

Provide details about your vaccination history, including the type of vaccine received, the dates of vaccination, and the healthcare provider who administered the vaccines.

04

Sign and date the form to certify that the information provided is true and accurate.

Who needs vaccination attestation form htfaen?

01

Individuals who have received vaccinations and need to provide proof of their vaccination history may need to fill out the vaccination attestation form htfaen.

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What is vaccination attestation form htfaen?

The vaccination attestation form htfaen is a document used to certify that an individual has been vaccinated against a particular disease.

Who is required to file vaccination attestation form htfaen?

Individuals who have received the vaccination and need to provide proof of their vaccination status are required to file the vaccination attestation form htfaen.

How to fill out vaccination attestation form htfaen?

To fill out the vaccination attestation form htfaen, individuals need to provide their personal information, details of the vaccination received, and any supporting documents.

What is the purpose of vaccination attestation form htfaen?

The purpose of the vaccination attestation form htfaen is to verify and confirm an individual's vaccination status for a specific disease.

What information must be reported on vaccination attestation form htfaen?

The vaccination attestation form htfaen must include the individual's name, date of birth, details of the vaccination received (such as vaccine type, date of administration), and any supporting documents.

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