Influenza Vaccine Screening
Patient's Date of Birth
Type a question
Is the person to be vaccinated sick today?
Does the person to be vaccinated have an allergy to a component of the vaccine?
Has the person to be vaccinated ever had a serious reaction to influenza vaccine in the past?
Has the person to be vaccinated ever had Guillain-Barre syndrome?
For information on the flu vaccine, click here:
Inactivated Influenza VIS
Should be Empty:
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