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denotes required field
I certify the student(s) assigned to all Virtua sites during December 1st-March 30th have received the influenza vaccine and have documentation on file for each student available for review upon request.
certifies the following documents are on file for Student(s) and will be made available to Virtua within 24 hours of being requested.
Please check next to each item that has been completed according to Virtua’s placement