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Influenza Vaccination Written Declination Form Office of the Registrar 9700 West Aaron Drive Elk Grove, CA 95757 Registrar CNS.edu I DO NOT WANT A FLU SHOT. I acknowledge that I am aware of the following
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How to fill out influenza vaccination written declination
How to fill out influenza vaccination written declination:
01
Obtain the influenza vaccination written declination form from your healthcare provider or employer. This form is usually provided when a person is required to have an influenza vaccination but chooses not to receive it.
02
Fill out your personal information, including your full name, date of birth, and contact information. Ensure that all details are accurate and up to date.
03
Read and understand the statements and terms on the form. These may include information about the risks and benefits of influenza vaccination, as well as potential consequences for not receiving the vaccine.
04
Consider consulting with a healthcare professional if you have any questions or concerns about the influenza vaccine or the declination form. They can provide you with accurate information to help you make an informed decision.
05
Sign and date the form to indicate your decision to decline the influenza vaccination. Make sure to use your legal signature and provide the current date.
06
Return the completed form to the designated recipient, which may be your employer, healthcare provider, or any other relevant authority. Keep a copy of the form for your records.
Who needs influenza vaccination written declination?
01
Individuals who are required to receive influenza vaccination but choose not to get it may need to fill out an influenza vaccination written declination.
02
This may include employees working in healthcare settings, schools, or other establishments where influenza vaccination is a requirement.
03
Individuals with valid medical reasons or religious beliefs may also need to provide a written declination if they choose not to receive the influenza vaccine. In such cases, it is advisable to consult with the appropriate authorities or healthcare professionals to understand the specific requirements and procedures for filling out the form.
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