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Flu vaccine waiver form 2023 hospital broward general

Flu Consent and Declination Form - Broward Health - browardhealth 2026

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The document is a declination form for non-Broward Health employees and students regarding the influenza vaccination. It outlines the importance of the vaccine in preventing serious illness and protecting patients and staff, while also detailing potential consequences of refusing vaccination. The individual acknowledges understanding these facts but chooses to decline the vaccine for various personal reasons, which they can specify. The form emphasizes that Broward Health does not provide vaccinations to non-employees and provides instructions for submitting the declination.

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Click ‘Get Form’ to open it in the editor.
Begin by reading the introductory section carefully. It outlines the importance of the influenza vaccination for healthcare workers.
In the acknowledgment section, review the facts about influenza and its risks. This will help you understand the implications of your decision.
Next, check all applicable reasons for declining the vaccination in the provided checkboxes. Make sure to select all that apply to your situation.
If you have already received a flu shot this year, indicate where you received it by selecting from the options or writing in another location.
Sign and date the form at the bottom to confirm your understanding and decision regarding vaccination.
Finally, submit your completed form as directed based on your role within Broward Health.

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How to get a religious exemption for a flu shot?

California removed its personal and religious exemption option in 2015. Parent/guradian must complete an online educational module to receive a non-medical exemption. Connecticut removed its religious exemption option in 2021.

Is Broward Health public or private?

Discover the Incredible Story of Broward Health One of the largest public healthcare systems in the United States.

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.

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