Www.wichita.edu
I have been offered a copy of the Influenza (Flu) Vaccine Information Statement (VIS). I have read, had explained to me, and understand the information in the VIS. I ask that the vaccine be administered to me. I consent to inclusion of this immunization data in the Kansas Immunization Information System (KSWebIZ) for myself. ... 10/14/2020 11 ... ................
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