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2019 Vaccine Clinic
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2019 Vaccine Clinic
Facility Name:
(required)
Standard Trivalent Flu Shots: (for employees)(# of doses estimated)
Quadrivalent Flu Shots: (# of doses estimated)
Pneumovax-23 Shots: (# of doses estimated)
Prevnar-13 Shots (# of doses estimated)
Zostavax (shingles) Shots: (# of doses estimated)
Flumist Nasal Spray - 39yoa or younger (# of doses estimated)
Shingrix
Name of Staff Person Entering Information:
(required)
Contact Phone Number
(required)
Suggested Clinic Date
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