Get 2013 Influenza Vaccination Attestationdeclination Pdf Form

Filling out the 2013 Influenza Vaccination Attestation/Declination Pdf Form online is a straightforward process. This guide will provide you with step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to complete your influenza vaccination attestation or declination form online.

1. Click ‘Get Form’ button to obtain the form and open it in an appropriate format for editing.
2. Begin with the attestation section where you need to indicate whether you have received the influenza vaccination this season. Fill in the date you received the vaccine and the location where it was administered, including the place, city, and state.
3. Next, provide your signature, the date of your signature, and your printed full name. Additionally, include your date of birth; this information will be recorded in your student health record.
4. Review the acknowledgment section carefully. This section informs you of the importance of vaccination and outlines the potential consequences of refusing the vaccine. Ensure that you understand these facts fully.
5. If you choose to decline the vaccination, select the applicable reasons from the provided list of options such as severe allergy or religious beliefs. Specify if you are a student and whether you provide direct patient care.
6. Finally, complete the declination section, which includes signing, dating, and printing your full name again, along with your date of birth.
7. After filling out all sections, save your changes, then download, print, or share the completed form as required.

Complete the required documents online to ensure compliance and protect public health.