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HEALTH CARE PROVIDER INFLUENZA VACCINE CONSENT …
I consent to receiving the seasonal influenza vaccine. If signing for someone other than yourself, indicate your relationship to that other person: _____ If signing for someone other than myself, I confirm that I am the parent / legal guardian or substitute decision maker.
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COVID-19 Vaccination Clinic Demographic Form
www.healthunit.comCOVID-19 Vaccination Clinic Demographic Form Name (as it appears on piece of identification) ... Out of Province Health Card ... Physician or Nurse Practitioner) Name . Author: Gina Bhullar
APPENDIX C Sample COVID-19 Vaccination Medical …
www.healthunit.comAPPENDIX C – Sample COVID-19 Vaccination Medical Exemption Form MEDICAL EXEMPTION TO DECLINE THE COVID-19 VACCINE _____ has a medical exemption for the COVID-19 Vaccine in Printed Name of Employee relation to a condition indicated below. The following conditions are the only absolute medical exemptions from the COVID-19 vaccine: ...
APPENDIX A Sample COVID-19 Vaccination Policy
www.healthunit.comAPPENDIX A – Sample COVID-19 Vaccination Policy [POLICY TITLE] (e.g., COVID-19 VACCINATION POLICY) PURPOSE To ensure that [Organization’s Name] employees are adequately immunized to minimize their risk of infection and to reduce the risk of transmission to others. POLICY STATEMENT
14. No Smoking Policy (Sample) POLICY
www.healthunit.comSmoking is prohibited at all times, with the exception of during specified breaks, at which time the employee must smoke in designated outdoor areas. 4. No Smoking signs must be posted at all entrances and exits, washrooms, and in workplace vehicles. 5. If an employee does not comply with this policy, the issue will be dealt
6. Infection Control Policy (Sample) Infection Control
www.healthunit.comand use routine infection control precautions and; 2) are aware of recommended immunizations for adults that help to prevent the transmission of infections amongst employees. POLICY: All staff will adhere to routine infection control precautions and will keep immunization status up to date in accordance with Ministry of Health
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INFLUENZA VACCINE CONSENT FORM 2021/2022
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Influenza (flu) vaccine information and Consent Form: 2016 ...
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www.cdc.govInfluenza vaccine can prevent influenza (flu). Flu is a contagious disease that spreads around the United States every year, usually between October and May. Anyone can get the flu, but it is more dangerous for some people. Infants and young children, people 65 years and older, pregnant people,
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Table 3: Recommendations* for Interrupted or Delayed ...
www.who.intSeasonal influenza (inactivated tri- and qudri-valent) ≥ 9 yrs: 1 dose21 6 months (min) < 9 yrs: 2 doses (4 weeks) Resume without repeating previous dose 2 doses < 9 yrs: 2 doses ≥ 9 yrs: 1 dose Revaccinate annually 1 dose only Varicella 22 12-18 months 1-2 (4 weeks – 3 months, depending on manufacturer) Resume without repeating previous dose
INTER-FACILITY TRANSFER FORM - Veterans Affairs
www.va.gov5. Sign transfer form after all above are completed; attach copy of records going with patient to receiving facility. Retain original with hospital records. TO BE COMPLETED FOR EVERY TRANSFER REQUEST TO AND FROM A VA MEDICAL FACILITY SECTION I - DEMOGRAPHIC AND ELIGIBILITY INFORMATION. 1. VETERAN'S LAST NAME- FIRST …