Does Medicare Cover Flu Shots Fill Out and Sign Printable PDF
Flu Declination Form. Web signature date name (print) department reference: Prevention and control of seasonal influenza with vaccines:.
Web i am declining due to the following reasons (check all that apply): Prevention and control of seasonal influenza with vaccines:. Web signature date name (print) department reference: I believe i will get influenza if i get the vaccine.
Web i am declining due to the following reasons (check all that apply): Prevention and control of seasonal influenza with vaccines:. Web i am declining due to the following reasons (check all that apply): I believe i will get influenza if i get the vaccine. Web signature date name (print) department reference:
