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CONSENT FOR INFLUENZA VACCINE ADMINISTRATION PATIENT NAME:___DOB:___Screening Questions for Contraindications to Inactivated Injectable Influenza Vaccination Answer the following Screening Questions

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How to fill out influenza - cdph

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Step 1: Visit the California Department of Public Health website

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Step 2: Locate the influenza form

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Step 3: Fill out the required fields with accurate information

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Step 5: Submit the completed form according to the instructions provided

Who needs influenza - cdph?

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Individuals who are required to report influenza cases to the California Department of Public Health

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Healthcare providers who diagnose and treat patients with influenza

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Laboratories conducting testing for influenza

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Influenza - cdph refers to the California Department of Public Health's reporting requirements for influenza cases.

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Information such as patient demographics, symptoms, test results, and vaccination status must be reported on influenza - cdph.

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