Wednesday, November 6, 2013


This is great! If you work in a hospital or any medical environment where they are requiring you to take a vaccine, stand up for your rights and send them this form!

Nurse Successful in Flu Vaccine Refusal

This is what one nurse wrote on facebook yesterday! And she was successful..... along with all others after her.

share this everywhere there may be nurses and others -

"A friend of mine from high school is a nurse, and was recently told she is required to get the flu vaccine. For her, this was enough of a compromise, and I'm proud of her for standing up for herself! She was willing to allow me to share it with you all (names protected) in the hopes that it is helpful to someone else. She wrote this letter to
the organization she works for:

To: Director of Business Administration & Director of Nursing
(Company Name and Address)
Re: Required Flu Vaccine for all associates

I feel I have signed the Acceptance Statement for the required Flu Vaccine without understanding of my constitutional rights, employee handbook rights and mostly out of fear of losing my job. As I am now required by (Company Name)'s new standard and practices to be vaccinated for the flu against my strong moral beliefs, which was not an option listed on the Declination Statement (though remains common practice still in most (US State) healthcare facilities) and was not required at my time of agreeing to employment at (Company Name), I would like to ask that (Company Name) please provide the following to me before required administration of this vaccination:

1. Name and Contact information of the ordering Physician.
2. Name and Contact information of the vaccination&# 39;s manufacturer.
3. All ingredients of the immunization.
4. Acceptance of responsibility statement, signed below: If ischemic brain damages, long or short term neurological damages or any adverse reactions emerge in this employee:

(Employee Name) post vaccination,

(Company Name) accepts full responsibility for the brain and health damages and any related loss or damages suffered to this employee relating to this flu vaccination which is required for the employee to remain scheduled and for her to avoid disciplinary action up to and including separation of employment, as an employee of (Company Name.

Printed Name

Position ______________________________________________

Signed Name Date" ________________________________________________________