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                Get Broward Health Seasonal Influenza Attestation/declination Form
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How to fill out the Broward Health Seasonal Influenza Attestation/Declination Form online
Filling out the Broward Health Seasonal Influenza Attestation/Declination Form online is a straightforward process. This guide will walk you through each section of the form, ensuring you can complete it accurately and efficiently.
Follow the steps to successfully complete the form.
- Press the 'Get Form' button to obtain the form and open it for editing.
- Begin by filling in the 'School/Company' field with the name of your educational institution or workplace.
- Next, enter your 'Program' name to specify your field of study or job position.
- In the 'Rotation Dates' section, provide the appropriate dates relevant to your program or employment.
- Complete the 'Title' field with your designation, followed by your first, middle, and last name in the designated spaces.
- Input the last four digits of your Social Security Number in the appropriate field to help identify your record.
- Indicate the 'Date Vaccine Received' if you are submitting documentation for vaccination.
- Have a responsible party review your proof of the vaccine and initial next to 'Proof of vaccine submitted and reviewed by school.'
- Choose whether you are accepting or declining the vaccine by signing and dating the appropriate section of the form.
- Once all fields are completed, review the form for accuracy. You can save changes, download, print, or share the completed form as needed.
Complete your documents online today to ensure your health and safety.
Related links form
In many cases, employers can require flu vaccinations for employees, especially in healthcare settings. However, employees may decline by properly filling out the Broward Health Seasonal Influenza Attestation/Declination Form. Understanding your rights and reviewing company policies can provide clarity on this issue.
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