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 Flu Shot Administration Form 2003

Flu Shot Administration Form 2003

Use a flu shot administration form 2003 template to make your document workflow more streamlined.

Public Health “Notice of Privacy Practices.” Signature: __________________________________________________________________________________________________ OFFICE USE ONLY Date of Vaccine and VIS Given Vaccine Given Type and Date of VIS Manufacturer and Lot Number Influenza Clinic Site Site of Injection LA RA Route LT RT IM SQ Signature of Nurse Income Assessment: Medicaid Y____ N____ American Indian/Alaskan Native Y____ N____ Insurance Y____ N____ Annual Income...
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