CA Kaiser Permanente Influenza Vaccination Declination Form 2025

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The document is a declination form for the 2021-2022 influenza vaccine, specifically for healthcare workers in Northern California. It outlines the serious risks associated with influenza, the importance of vaccination, and the consequences of declining the vaccine, including the requirement to wear a mask during patient care. The form allows individuals to specify their reasons for declining vaccination and acknowledges their understanding of the risks involved.

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Versions	Form popularity	Fillable & printable
2021	4.8 Satisfied (171 Votes)
2016	4.1 Satisfied (48 Votes)

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How do I write a letter to not get the flu shot?

my health and the health of everyone with whom I have contact, including my coworkers and all patients in this healthcare facility. Despite these facts, I am choosing to decline influenza vaccination for the following reasons: I understand that I can change my mind at any time and accept influenza vaccination.

How to decline flu vaccine at work?

This facility has recommended that I receive influenza vaccination in order to protect myself and the patients I serve. I DO NOT WANT A FLU SHOT. I acknowledge that I am aware of the following facts: Influenza is a serious respiratory disease; on average, 36,000 Americans die every year from influenza-related causes.

What are valid reasons to decline the flu vaccine?

6 reasons patients avoid flu vaccination Im healthy, so I dont need a flu vaccine. The flu vaccine isnt safe and can give me the flu. It is better to get sick with the flu. Ill wait until flu hits my area. I hate getting injections. I was vaccinated last year.

What are the reasons for flu shot exemption?

There are medical reasons that the flu shot is not for everybody- are called medical exemptions. You should not get the flu shot if you have a documented severe allergy to the vaccine or any vaccine component or if you have a history of Guillain-Barr Syndrome within 6 weeks of a receiving a flu shot.

Can I get a free flu shot at Kaiser?

One vaccine a year is recommended for most people. For their first season of flu vaccination, children 6 months to 8 years need 2 flu shots a minimum of 4 weeks apart. Kaiser Permanente members can get a flu shot at no cost during flu season, beginning in early fall.

What to put on flu declination form?

I have been given the opportunity to be vaccinated against this infection at no charge to me. However, I decline this vaccination at this time. I understand that by declining this vaccine, I continue to be at increased risk of acquiring influenza.

Why am I not eligible for the flu vaccine?

Who cannot have the flu vaccine. Most people who are eligible for the flu vaccine can have it. You only cannot have the vaccine if youve had a serious allergic reaction (anaphylaxis) to a previous dose of the vaccine or an ingredient in the vaccine. Some of the flu vaccines used in the UK contain egg protein.

CA Kaiser Permanente Influenza Vaccination Declination Form 2025

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