{"id":2029,"date":"2024-05-10T07:44:26","date_gmt":"2024-05-10T07:44:26","guid":{"rendered":"https:\/\/remitystaffing.cumulative-projects.com\/?page_id=2029"},"modified":"2024-06-20T13:01:51","modified_gmt":"2024-06-20T13:01:51","slug":"influenza-vaccination-declaration","status":"publish","type":"page","link":"https:\/\/www.remitystaffing.com\/india\/influenza-vaccination-declaration\/","title":{"rendered":"Remity Staffing &#8211; Influenza Vaccination Declaration"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-post\" data-elementor-id=\"2029\" class=\"elementor elementor-2029\">\n\t\t\t\t<div class=\"elementor-element elementor-element-1337320 e-flex e-con-boxed e-con e-parent\" data-id=\"1337320\" data-element_type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-8c47842 e-con-full e-flex e-con e-child\" data-id=\"8c47842\" data-element_type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-6020073 elementor-widget elementor-widget-heading\" data-id=\"6020073\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Remity Staffing - Influenza Vaccination Declaration<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-d6ed0c3 e-flex e-con-boxed e-con e-parent\" data-id=\"d6ed0c3\" data-element_type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-d91fcb1 e-flex e-con-boxed e-con e-child\" data-id=\"d91fcb1\" data-element_type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-6ece17a elementor-widget elementor-widget-shortcode\" data-id=\"6ece17a\" data-element_type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\">\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f2034-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"2034\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/india\/wp-json\/wp\/v2\/pages\/2029#wpcf7-f2034-o1\" method=\"post\" class=\"wpcf7-form init cf7skins cf7s-default\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"2034\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.0.6\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f2034-o1\" \/>\n<input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/>\n<input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<input type=\"hidden\" name=\"_wpcf7cf_hidden_group_fields\" value=\"[]\" \/>\n<input type=\"hidden\" name=\"_wpcf7cf_hidden_groups\" value=\"[]\" \/>\n<input type=\"hidden\" name=\"_wpcf7cf_visible_groups\" value=\"[]\" \/>\n<input type=\"hidden\" name=\"_wpcf7cf_repeaters\" value=\"[]\" \/>\n<input type=\"hidden\" name=\"_wpcf7cf_steps\" value=\"{}\" \/>\n<input type=\"hidden\" name=\"_wpcf7cf_options\" value=\"{&quot;form_id&quot;:2034,&quot;conditions&quot;:[{&quot;then_field&quot;:&quot;group-500&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;radio-influenza&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;Type&quot;}]}],&quot;settings&quot;:{&quot;animation&quot;:&quot;yes&quot;,&quot;animation_intime&quot;:200,&quot;animation_outtime&quot;:200,&quot;conditions_ui&quot;:&quot;normal&quot;,&quot;notice_dismissed&quot;:false,&quot;notice_dismissed_rollback-cf7-5.9.3&quot;:true,&quot;notice_dismissed_rollback-cf7-5.9.5&quot;:true}}\" \/>\n<\/div>\n<div class=\"uacf7-form-2034  \"><div class=\"formbox\">\n\t<div class=\"row\">\n\t\t<div class=\"col-full\">\n\t\t\t<h3>Remity Staffing - Influenza Vaccination Declaration<\/h3>\n\t\t\t<p class=\"mb-3\">Every year the influenza vaccination is offered to NHS staff as a way to reduce the risk of staff contracting the flu virus and transmitting it to patients or their family members. Healthcare workers may transmit the illness to patients even if they are mildly or sub-clinically infected. Influenza is a highly transmissible infection. Occupational health teams leads the delivery of vaccinations across the NHS trusts.<\/p>\n\t\t<\/div>\n\t\t<div class=\"col-half\">\n\t\t\t<div class=\"radio_checkbox\">\n\t\t\t\t<label>Have you had the Influenza Vaccination?<span class=\"required\">*<\/span><\/label>\n\t\t\t\t<span class=\"wpcf7-form-control-wrap\" data-name=\"vaccinated\"><span class=\"wpcf7-form-control wpcf7-radio multi_options\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"vaccinated\" value=\"Yes\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"vaccinated\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-half\">\n\t\t\t<label>If yes, can you please state the date below<\/label>\n\t\t\t<span class=\"wpcf7-form-control-wrap\" data-name=\"vacinatted_yes\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-date form-control\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"vacinatted_yes\" \/><\/span>\n\t\t<\/div>\n\t\t<div class=\"col-full\">\n\t\t\t<label> If no, please provide the steps below in how and when you aim to retrieve an annual flu Jab <\/label>\n\t\t\t<span class=\"wpcf7-form-control-wrap\" data-name=\"vacinatted_no\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"vacinatted_no\" \/><\/span>\n\t\t<\/div>\n\t\t<div class=\"col-half\">\n\t\t\t<label>First Name<span class=\"required\">*<\/span><\/label>\n\t\t\t<span class=\"wpcf7-form-control-wrap\" data-name=\"fname\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"fname\" \/><\/span>\n\t\t<\/div>\n\t\t<div class=\"col-half\">\n\t\t\t<label>Last Name<span class=\"required\">*<\/span><\/label>\n\t\t\t<span class=\"wpcf7-form-control-wrap\" data-name=\"lname\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"lname\" \/><\/span>\n\t\t<\/div>\n\t\t<div class=\"col-half\">\n\t\t\t<label>NMC \/ GMC Number<span class=\"required\">*<\/span><\/label>\n\t\t\t<span class=\"wpcf7-form-control-wrap\" data-name=\"gmc_nmc_num\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"gmc_nmc_num\" \/><\/span>\n\t\t<\/div>\n\t\t<div class=\"col-half\">\n\t\t\t<label>Date<span class=\"required\">*<\/span><\/label>\n\t\t\t<span class=\"wpcf7-form-control-wrap\" data-name=\"date\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date form-control\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"date\" \/><\/span>\n\t\t<\/div>\n\t\t<div class=\"col-half\">\n\t\t\t\t<div class=\"formgroup sing\">\n\t\t\t\t\t\t<label>Signature<span class=\"required\">*<\/span><\/label>\n\t\t\t\t\t\t<div class=\"dscf7_signature\">\n\t\t\t<div class=\"dscf7_signature_inner\">\n\t\t\t\t<canvas id=\"digital_signature-pad_influenza\" name=\"influenza\" class=\"digital_signature-pad\" color=\"#000000\" backcolor=\"#FAFAFA\" width=\"460\" height=\"200\"><\/canvas>\n\t\t\t\t<input class=\"clearButton\" type=\"button\" value=\"+\">\n\t\t\t<\/div>\n\t\t\t<span class=\"wpcf7-form-control-wrap influenza\">\n\t\t\t\t<input class=\"wpcf7-form-control wpcf7-signature wpcf7-validates-as-requiredwpcf7-validates-as-signature form-controldscf7-signature\" value=\"\" type=\"hidden\" name=\"influenza\"\/>\n\t\t\t\t<input type=\"hidden\" name=\"influenza-attachment\" class=\"wpcf7_input_influenza_attachment\"\/>\n\t\t\t\t<input type=\"hidden\" name=\"influenza-inline\" class=\"wpcf7_input_influenza_inline\"\/>\n\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<div class=\"radio_checkbox\">\n\t\t\t\t\t\t\t<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-influenza\"><span class=\"wpcf7-form-control wpcf7-radio multi_options\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"radio-influenza\" value=\"Draw\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Draw<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"radio-influenza\" value=\"Type\" \/><span class=\"wpcf7-list-item-label\">Type<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<span data-id=\"group-500\" data-orig_data_id=\"group-500\" data-clear_on_hide data-class=\"wpcf7cf_group\">\n\t\t\t\t\t\t\t<input type=\"text\" name=\"sign_text form-control\" id=\"sign_text\" 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