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Proof of Immunization Compliance (1411.1 Health Services Form)
Handle: Document-3543
Owner: Laiche, Karen (User-23, klaich:DocuShare)DS
Thursday, January 15, 2009 09:12:18 AM CST
Thursday, January 15, 2009 09:12:18 AM CST
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  • The reason or ot eing accinated is: ersonal unavailability of he vaccine I have rovided a statement verifying thatave tried to eceive he accine ut ould ot nd ny.)
  • I do urther ereby now and forever free nd elease he university and the Department f Health nd ospitals nd ll ts gents, ttending ealth care rofessionals, nd other personnel from ny nd ll egal r financial esponsibility asesult of his refusal.
  • evidence of accination r immunity gainst easles, ubella, umps, etanus nd iphtheria can be established by ither reviewing a previous ritten ecord of accination r administering vaccine now.
  • n all instances when accine dministration is considered, -M M-R (m measles, umps nd ubella accine ive) nd etanus-d diphtheria oxoid (T Td, dult ype) ...
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1411-1 Proof of Immunization Compliance - Health Services Website 1-09.pdf
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86825
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Appears In: ALL FORMS - Alphabetically Listed by Form Title DELGADO FORMS
Preferred Version: Proof of Immunization Compliance (1411.1 Health Services Form)