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COVID-19 Vaccine Screening & Consent Form
Last NameFirst Nameserver: Female Male NonBinary
Prefer not to answer Other:Identification (e.g., health card #)
Primary Care Clinician:Home Phone Mobile
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What is a paperwork hurdle for?
A paperwork hurdle is for documenting and reporting necessary information.
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Any individual or organization that is required by law to document and report specific information.
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