This is the template for the flu vaccination report. EA = Egg allergy, IA = Ingredient Allergy, GBS = sGuillain Barre Syndrome, OTH = other
Probably can do without yes or no column so didn't include. If no immunization date, then it would be a no and a check would be in one of the declination reason column.
Flu Vaccination Report
| HC Facility | School/Program | Name | Date | Provider/Location | EA | IA | GBS | OTH | ||
|---|---|---|---|---|---|---|---|---|---|---|
