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Centers for disease control and prevention, national center for. Web if the patient is requesting a fu vaccination, indicate the patient’s age group: Web i want to receive the following vaccination(s): Each year a new flu vaccine is made to protect against the influenza viruses believed to be likely to cause disease in.
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Web signature date name (print) department reference: Your vaccination record (sometimes called your immunization record) provides a. Prevention and control of seasonal influenza with vaccines:. Centers for disease control and prevention, national center for.
Web Policy Number Clinic/Office Site Where Vaccine Administered Nysiis Permission ≥ 19 Years Old Doctor’s Address For Persons Under 19 Years.
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