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Rice County Public HealthCONSENT TO RECEIVE
INFLUENZA VACCINE
Last Name(please print)320 NW Third St; Suite 1
Arnault, MN 55021
5073326111
www.co.rice.mn.usFirst NameMiddle Initial Birth Date (mo/day/year)Street
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How to fill out consent to receive influenza
How to fill out consent to receive influenza
01
Obtain the consent form from a healthcare provider or institution offering influenza vaccination.
02
Read and understand all the information provided in the consent form.
03
Fill out all the required personal information accurately, such as name, date of birth, contact details, etc.
04
Sign and date the consent form to indicate your agreement to receive the influenza vaccination.
05
Return the completed consent form to the healthcare provider or institution before getting the vaccination.
Who needs consent to receive influenza?
01
Anyone who wishes to receive the influenza vaccination must fill out and submit a consent form.
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What is consent to receive influenza?
Consent to receive influenza is a form that allows individuals to give permission to receive the influenza vaccine.
Who is required to file consent to receive influenza?
Individuals who wish to receive the influenza vaccine are required to file consent to receive influenza.
How to fill out consent to receive influenza?
To fill out consent to receive influenza, individuals must complete the form with their personal information and sign to indicate their agreement to receive the vaccine.
What is the purpose of consent to receive influenza?
The purpose of consent to receive influenza is to ensure that individuals are aware of and agree to receive the influenza vaccine.
What information must be reported on consent to receive influenza?
Information such as name, date of birth, contact information, and signature is typically required to be reported on consent to receive influenza.
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