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- Canada United Pharmacy Clinical Services Informed Consent For Immunization 2020
Get Canada United Pharmacy Clinical Services Informed Consent For Immunization 2020-2024
Ph #: Street City State Zip Please provide date when vaccine was last received: Flu: Pneumonia: Shingles: Tetanus: Screening Questionnaire: Please answer the questions by checking the boxes FOR ALL VACCINES: Do you feel ill today (fever/cough or shortness of breath/diarrhea 3 days/vomiting)? In the last 14 days, have you had contact with a lab confirmed COVID-19 patient? Have you ever had a.
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