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Get and Sign Shoprite Form
SCREENING FOR INJECTABLE VACCINE ELIGIBILITY SCREENING QUESTIONS Click on only one response YES or NO from the appropriate column for EACH question YES NO Are you sick today Do you have a fever diarrhea or vomiting today Are you allergic to eggs Baker s yeast preservatives sulfites thimerosal streptomycin neomycin arginine gelatin or latex Have you ever had a serious reaction to any vaccine Are you anyone in your home or anyone you take care of being treated with chemotherapy or radiation for...
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