FluSurv-Net Influenza Hospitalization Surveillance Project Provider Vaccination History Fax Form (Children/Adults)

[NCEZID] Emerging Infections Program

OMB: 0920-0978

IC ID: 231111

Documents and Forms

Document Name Document Type
Form 0920-0978-24BX FluSurv-Net Influenza Hospitalization Surveillance Project Provider Vaccination History Fax Form (Children/Adults) Form and Instruction
Form 0920-0978-24BX FluSurv-Net Influenza Hospitalization Surveillance Project Provider Vaccination History Fax Form (Children/Adults) Form and Instruction
0920-0978-24BX FluSurv-Net Influenza Hospitalization Surveillance Project Provider Vaccination History Fax Form (Children/Adults) Att14- FluSurv-Net_Provider Vaccination HIstory_Children_Adult.pdf Form and Instruction