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Providence VA Medical Center, Rhode Island

 

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Hyannis CBOC FLU Clinic (Mon- Fri)

Date: Wednesday, January 04, 2017
Time: 1:00 PM- 3:00 PM (EST)  
Location: Hyannis CBOC
   
IMPORTANT... IMPORTANT... IMPORTANT

If you get your flu shot for this season (August 2016 – May 2017) somewhere else, we want to update your VA medical record with that information.   Please do one of the following:

? Complete the information below and return this sheet to any clerk,
OR
? Call 1-866-363-4486, extension 1499 and leave a message with your information,
OR
? Send a secured message to your health care team through My HealtheVet with the month and year that you received your vaccination.


Please fill in below if you receive a flu shot at a location outside of the VA:

First Name: ____________________ Last Name: ___________________

Date of Birth: ________________    Phone number: (____)________________
                            month/day/year

During the 2016/2017 Flu Season, I received my flu shot in the community on _____ /____
                                                                                                                                          MONTH/YEAR
You can leave this form with any clerk