Kaiser permanente flu shot form signed 2025

See details

4.1 out of 5

48 votes

The document is an Influenza Vaccine Form for the 2016-2017 season, intended for employees in Northern California. It includes sections for employees to indicate whether they received the flu vaccine, acknowledge the risks of influenza, and state their reasons for declining vaccination. The form emphasizes the importance of vaccination for healthcare workers and outlines requirements for those who choose not to get vaccinated, such as wearing a mask during patient care.

Here's how it works

01. Edit your flu shot kaiser online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send flu shot kaiser 2022 via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out kaiser permanente flu shot form signed with our platform

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Click ‘Get Form’ to open the kaiser permanente flu shot form in the editor.
Begin by entering your name, department, medical record number, and employee number in the designated fields at the top of the form.
Indicate whether you received the 2016-2017 Flu Vaccine by checking the appropriate box for either injection or nasal spray. Provide the approximate date of vaccination if available.
If you choose not to receive the flu vaccine, check the box indicating your decision and read through the acknowledgment statements regarding influenza risks.
Select any reasons for declining vaccination by checking all applicable boxes. If necessary, provide additional details in the space provided.
Sign and date the form at the bottom to confirm your choices and understanding of the information presented.

Start using our platform today to easily complete your kaiser permanente flu shot form online for free!

See more kaiser permanente flu shot form signed versions

We've got more versions of the kaiser permanente flu shot form signed form. Select the right kaiser permanente flu shot form signed version from the list and start editing it straight away!

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

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

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

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.

How to document a flu vaccine?

Job Aid Date of administration. Vaccine manufacturer. Vaccine lot number. Name and title of the person who administered the vaccine and address of the facility where the permanent record will reside. Vaccine information statement (VIS) Date printed on the VIS. Date the VIS was given to the patient or parent/guardian.

How to prove you got a flu shot?

Digital Vaccine Record Portal: Get a digital copy of your vaccine record from the California Immunization Registry (CAIR2). CAIR2 is a secure, confidential, statewide computerized immunization information system for California residents.

Is flu shot free with Kaiser?

Kaiser Permanente members can get a flu shot at no cost during flu season, beginning in early fall.

What must be documented after giving a vaccine?

Obtain the Childs Personal Immunization Record The personal immunization record must: ✓ identify the student by name and date of birth ✓ show the date (month, day, and year) each required vaccine dose was received ✓ have the type of vaccine received ✓ include the name of the physician or agency who gave the vaccine.

flu shot kaiser permanente

kaiser walk-in flu shot locations kaiser flu shot walk-in Are flu shots available at Kaiser now Kaiser flu shot near me Kaiser flu shot walk in Northern California Kaiser flu shot schedule Kaiser flu shot South San Francisco Kaiser flu shot Southern California

Related forms

be ready to get more

Complete this form in 5 minutes or less

Get form

How to print kaiser immunization record?

Need to download and print your immunization record? Log in to kp.org. Select Medical Record at the top of the home page. Select the Immunizations tile. Then click on Print your official immunization record. Your Official Immunization report will open in a separate window. Right click on the page. Select Print.

Kaiser permanente flu shot form signed 2025

Here's how it works

How to use or fill out kaiser permanente flu shot form signed with our platform

See more kaiser permanente flu shot form signed versions

Complete this form in 5 minutes or less

Got questions?

What are valid reasons to decline the flu vaccine?

How to document a flu vaccine?

How to prove you got a flu shot?

Is flu shot free with Kaiser?

What must be documented after giving a vaccine?

Complete this form in 5 minutes or less

People also ask

How to print kaiser immunization record?

kaiser drive through flu shot 2022

Try more PDF tools