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Vaccine administration consent form information - HEB

Vaccine administration consent form information - HEB 2025

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The document is a screening questionnaire and consent form for vaccination at Larchmont Pharmacy LLC. It collects patient information, medical history, and consent for vaccine administration. The form includes questions about allergies, medical conditions, and previous vaccinations to determine eligibility for immunization. It also outlines the responsibilities of the patient regarding payment and record-keeping, as well as the pharmacy's policies on privacy and liability.

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