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How to use or fill out kaiser permanente flu shot form signed with our platform
- Click ‘Get Form’ to open the kaiser permanente flu shot form in the editor.
- Begin by entering your personal information in the designated fields: Name, Department, Medical Record #, and Employee Number #.
- Indicate whether you received the 2016-2017 Flu Vaccine by checking the appropriate box for Injection or Nasal spray. Provide the approximate date of vaccination if available.
- If you choose not to receive the vaccine, check the box indicating your decision and read through the acknowledgment statements regarding influenza risks.
- Select your reason for declining vaccination by checking all applicable boxes under 'I decline vaccination for the following reason(s)'.
- Sign and date the form at the bottom to confirm your choices and understanding of the information provided.
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