Declination of Influenza Vaccination. My employer or affiliated health facility,, recommends that I receive influenza vaccination to protect myself, patients, staff, and others in the healthcare facility. I acknowledge that I am aware of the following facts (please read and check each box): Influenza is a serious respiratory disease. Oct 01, · Vaccination coverage with ≥1 dose of flu vaccine was % among children 6 months through 17 years, an increase of percentage points from the –19 flu season, and flu vaccination coverage among adults ≥18 years was %, an increase of .
Jan 29, · Declination of influenza vaccination: Form for healthcare worker signature and date, lists important reasons for annual influenza vaccination and consequences of vaccine refusal [#P] Key vaccination resources for healthcare professionals. CMS requires reporting on influenza vaccination for three categories of HCP: employees, licensed independent practitioners (non-employee physicians, advanced practice nurses, and physician assistants), and adult students/trainees and volunteers aged 18 and over.
ADULT Influenza Vaccine Administration Record (VAR) PATIENT ELIGIBILITY (please check one) Undergraduate Student Graduate Student/Assistant Faculty/Staff Retiree Spouse/Dependent (on a medical plan) I. PATIENT INFORMATION. to record influenza, pneumococcal, zoster, Hib, and other vaccines each vaccine; for hepatitis B vac-cines, record the trade name (see table at right). penetrat.xyz the funding source of the vaccine given as either F (federal), S (state), or P (private). Vaccine Administration Record for Adults File Size: KB.