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CAREGIVER HEALTH SERVICES PLEASE RETURN COMPLETED FORM TO CAREGIVER (EMPLOYEE) HEALTH SERVICESSeasonal Influenza Declination Form 20232024 Providence St. Joseph Health offers the influenza vaccine
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How to fill out influenza policy and vaccination

01
To fill out an influenza policy and vaccination form, follow these steps:
02
Start by filling out your personal information, including your full name, date of birth, and contact details.
03
Provide your medical history, including any allergies or past reactions to vaccines.
04
Indicate if you have received the influenza vaccine in the past and provide the dates.
05
Answer questions regarding your current health status, such as if you are experiencing any flu-like symptoms.
06
Provide information about your primary healthcare provider and any additional healthcare providers you may have.
07
Read and understand the terms and conditions of the policy, and sign and date the form.
08
Submit the completed form to the designated authority or healthcare provider responsible for administering the influenza vaccine.

Who needs influenza policy and vaccination?

01
Influenza policy and vaccination are recommended for the following individuals:
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- All individuals aged 6 months and older
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- Pregnant women
04
- Adults aged 65 years and older
05
- Individuals with chronic medical conditions (such as asthma, diabetes, or heart disease)
06
- Healthcare workers
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- People living in long-term care facilities
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However, it is always best to consult with a healthcare professional or refer to official guidelines specific to your region to determine who exactly is recommended to receive the influenza policy and vaccination.
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Influenza policy refers to the guidelines and measures put in place to prevent and manage the spread of influenza, while vaccination entails administering the flu vaccine to individuals to enhance immunity against the virus.
Organizations, health care providers, and employers who are involved in the administration of influenza vaccinations are required to file influenza policy and vaccination reports.
To fill out the influenza policy and vaccination forms, individuals or organizations must provide relevant data on vaccination coverage, distribution methods, and compliance with health regulations as outlined by public health authorities.
The purpose of influenza policy and vaccination is to reduce the incidence of influenza outbreaks, protect public health, and ensure a high level of immunization within communities to prevent severe health complications.
Information that must be reported includes the number of vaccinations administered, demographic data of vaccinated individuals, adherence to vaccination protocols, and any adverse events following immunization.
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