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Get and Sign Influenza Vaccine Release Form
Serious allergic reaction to a Flu shot or Flu mist Have you had chemotherapy or immunosuppressive therapy within the past two weeks Do you have an active neurologic disorder Have you had Guillain-Barre Syndrome - paralyzing disorder Do you have a chronic medical condition such as diabetes asthma or heart disease Information about person to receive vaccine. I hereby release ASU from any and all liability from or in any way connected with the vaccination. I certify that the following information...
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