has component is about vaccination procedure asking vaccination patient used in geographic location question whether allergic to vaccine component questionnaire for Rite Aid vaccination consent vaccination patient with asthma female vaccination patient shingles vaccination Tdap vaccination vaccination patient over 65 years old questionnaire for Rite Aid vaccination consent in North Carolina http://content.riteaid.com/pharmacy/20150726_ScreeningQuesConsent.pdf Td vaccination vaccination patient with COPD vaccination patient with smoking habit question whether currently sick question whether allergic to latex question whether allergic to food question whether allergic to medication X-ray treatment question question on vaccination in past 4 weeks question on TB skin test in past 4 weeks question on long-term health problem question on long-term lung disease prednisone treatment question steroids treatment question question on current anti-cancer drug usage question on seizure, brain, or nerve problem question on blood or blood product transfusion, or immune (gamma) globulin in past year question on woman pregnancy now or during the next month question on cancer, leukemia, AIDS or any other immune system problem question whether allergic to gelatin question on vaccination caused disorder question on vaccination caused Guillain-Barre syndrome question on asthma history question on serious reaction after immunization question whether had Pneumococcal vaccination question whether had Shingles vaccination question whether had Tdap vaccination question on antiviral drug usage question on whether having cut, injury, puncture or open wound question whether react to triple antibiotic ointment question on health provider precaution or warning of specific vaccination question on faintig after vaccination question whether diagnosed with rheumatoid arthritis question whether diagnosed with ankylosing spondylitis question whether diagnosed with Crohn’s disease question whether bring imunization record card State of North Carolina