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Flu Clinic Consent Form Town of New Canaan

Flu Clinic Consent Form Town of New Canaan

Use a Flu Clinic Consent Form Town Of New Canaan template to make your document workflow more streamlined.

The influenza vaccine flu shot and the agency s policy. I authorize the release of any medical or other information necessary to process a Medicare claim. Signature of recipient or parent/guardian Date Signature of person completing form for recipient unable to read the form DO NOT WRITE BELOW THIS LINE Manufacture Injection site Left Arm FOR CLINIC USE Lot Expiration Date Right Arm Nurse s Signature Date. I have had a chance to ask questions which were answered to my satisfaction. I understand...
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