Record the number of patients for each category below for the month being reviewed.
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*Facility ID# :
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*Vaccination type: Influenza
| *Month:
| *Year:
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Patient categories
| Number of patients in each category
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*1. Total # of patient admissions
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2. Total # of patients previously vaccinated during current influenza season
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*3. Total # of patients meeting high risk criteria previously vaccinated during current influenza season
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