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State of CaliforniaHealth and Human Services AgencyCalifornia Department of Public Health Healthcare Associated Infections Program20222023 INFLUENZA VACCINATION WRITTEN DECLINATION FORM LOS ANGELES
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Step 1: Obtain the nrs-hca flu vaccine declination form.
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Step 2: Review the form and familiarize yourself with the information required.
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Step 3: Provide your personal information such as name, address, and contact details.
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Step 4: Indicate your reason for declining the flu vaccine by checking the appropriate box.
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Step 5: Sign and date the form to confirm your decision.
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Step 6: Submit the completed nrs-hca flu vaccine declination form to the relevant authority or department.

Who needs nrs-hca flu vaccine declination?

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People who wish to decline taking the nrs-hca flu vaccine are the ones who need the nrs-hca flu vaccine declination. This may include individuals who have medical contraindications, religious beliefs, or personal reasons for opting out of the vaccine.
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The NRS-HCA flu vaccine declination is a formal document that allows individuals to decline receiving the influenza vaccine while still complying with health regulations or employer mandates.
Individuals who are exempt from receiving the flu vaccine due to medical, religious, or personal reasons are typically required to file an NRS-HCA flu vaccine declination.
To fill out the NRS-HCA flu vaccine declination, individuals need to provide their personal information, state the reason for declination, and sign the document to acknowledge their understanding of the implications.
The purpose of the NRS-HCA flu vaccine declination is to document the decision of an individual to opt-out of the flu vaccination while ensuring that the organization can track compliance with health mandates.
The NRS-HCA flu vaccine declination must include personal identification details, the specific reason for declination, and a signature of the individual declaring their choice.
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