has component asking vaccination patient documented by used in geographic location United States of America vaccination screening questionnaire questionnaire for Costco vaccination consent YH, YL a questionnaire that is part of the Costco vaccination informed consent form. http://www2.costco.com/Images/Content/misc/PDF/Immunization_consent_form_v2-2012.pdf female vaccination patient question whether currently sick question whether allergic to latex question whether allergic to food question whether allergic to egg question whether allergic to medication question whether allergic to vaccine question on reaction after immunization seizure disorder question immunocompromisation question question on woman pregnancy cortisone treatment question X-ray treatment question question on vaccination in past 4 weeks question on blood transfusion in past year question on asthma or wheezing history question on long-term heart disease question on cancer question on leukemia United States of America Costco