Yellow Fever Physician Letter - Summit County Public Health - scphoh 2025

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering the patient's name and date of birth in the designated fields at the top of the form.
  3. Review the contraindications listed carefully. Ensure that you assess your patient’s medical history against these criteria.
  4. Indicate whether your patient can receive the yellow fever vaccine by checking the appropriate box: 'Can receive yellow fever vaccine' or 'Cannot receive yellow fever vaccine'.
  5. Print your name as the physician in the provided field, followed by your signature to validate the document.
  6. Fill in your contact information, including phone number and fax number, ensuring all details are accurate for follow-up.
  7. Finally, enter today’s date in the specified area before saving or exporting your completed form.

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