Flu Shots Coverage - Medicare 2026

1. Click ‘Get Form’ to open the Flu Shots Coverage - Medicare document in the editor.
2. Begin by selecting your insurance provider from the list provided. Check the box next to 'Medicare' if applicable.
3. Fill in your personal information in the 'Patient Information' section. Ensure you provide your last name, first name, date of birth, phone number, and address accurately.
4. Indicate your sex and complete any additional fields such as Member Identification # and Group #.
5. Answer the health-related questions regarding past reactions to flu shots, Guillain-Barre Syndrome history, egg allergies, and pregnancy status by checking 'YES' or 'NO'.
6. Read the consent statement carefully. If you agree, sign and date the form at the bottom.

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