Flu Vaccine Refusal

紐約州衛生署規定所有護理公司都需要將所有護理員的流感疫苗注射記錄存檔,請所有萬有護理員必須在 2024年 1月 12 號前向我們公司遞交流感疫苗注射記錄,如果你拒絕注射流感疫苗,請簽署拒絕聲明並交回給我們公司存檔。建議未接種疫苗的護理員在流感季節期間,在病人可能活動的區域始終佩戴口罩。
New York State Department of Health requires that our agency document the Influenza vaccination status of our home care workers. All home care workers, please submit the Influenza Vaccination documentation or Refusal Statement to our agency before 1/12/2024. It is recommended that unvaccinated personnel wear a surgical mask at all times while in the area where client(s) may be present during influenza season.
Full Name 姓名(Required)
Date of Birth 出生日期(Required)
透過下方簽名,我確認我已收到流感疫苗相關資訊, 我選擇不接受流感疫苗。我同意在流感季節期間,當我在病人可能活動的區域時,始終佩戴口罩。
By signing below, I acknowledge that I have received influenza vaccine information; I choose not to receive influenza vaccine. I agree to wear a surgical mask at all time while in area where clients may be present during Influenza season.
This field is for validation purposes and should be left unchanged.