The Rhode Island Department of Health has announced that it will make flu immunizations mandatory for all workers, students, trainees, and volunteers who may have routinely anticipated face-to-face interaction, also known as "direct contact," with patients at a healthcare facility. It is the first state in the country to adopt such a requirement. Healthcare workers and volunteers who are opposed to having a flu shot but are not medically exempt must submit a form annually by December 15 that states their refusal to be immunized against influenza and indicates their understanding that they are obligated to wear a surgical face mask during each routinely anticipated direct patient contact during any declared period in which the flu is widespread.