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Get Broward Health Seasonal Influenza Attestation/Declination Form

I am aware of the following facts: • Influenza is a serious respiratory disease that kills an average of 36,000 persons and hospitalizes more than 200,000 persons in the United States each year. • Influenza vaccine is recommended for me and all other healthcare workers to prevent influenza disease and its complications, including death. • If I become infected with influenza, I will shed the virus for 24-48 hours before influenza symptoms appear. • Even when my symptoms are mild or I hav.

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