Get Muha Intranet

Filling out the Muha intranet's influenza vaccination declination form can be straightforward with the right guidance. This guide provides step-by-step instructions to assist users in completing the form accurately and efficiently.

Follow the steps to complete the influenza vaccination declination form.

1. Press the ‘Get Form’ button to access the influenza vaccination declination form and open it in the designated editor.
2. In the employer section, clearly indicate the name of your hospital or institution by selecting from the options provided (e.g., Hospital/MUHA, University/MUSC, UMA/CFC, Crothall, or Sodexho).
3. Enter your last name, first name, middle initial, date of birth, last four digits of your Social Security number, home phone number, department, position, and work phone number in the respective fields.
4. Read the Vaccine Information Sheet provided and acknowledge your understanding by checking the box next to the statement confirming that you have done so.
5. Check all applicable reasons for declining the influenza vaccine. You can choose from options including religious beliefs, allergies to chicken eggs or egg products, a history of Guillain-Barré Syndrome, or personal choice.
6. Fill in the date on which you are completing the form, and provide your signature to certify your decision.
7. If you have medical contraindications, ensure to have them certified by a licensed physician, nurse practitioner, or physician assistant. They must provide their signature and title along with the date.
8. Once all sections are completed, you can save changes, download a copy, print the form, or share it as necessary.

Complete your influenza vaccination declination form online today.