Declination of Influenza Vaccination

Declination of Influenza Vaccination
Fresno Yosemite Health Care, Inc., recommends that I receive the influenza vaccination to protect myself, patients, staff, and others in the healthcare facility.

I acknowledge that I am aware of the following facts (please read and check each box):
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Despite these facts, I am choosing to declineinfluenza vaccination for the following reasons:
I have read and fully understand the information on this declination form.
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