Get the free MDPH Meningococcal Information and Waiver Form

This document provides information about meningococcal disease and the vaccination requirements for students living in congregate housing in Massachusetts. It also includes a waiver for students who

How to fill out mdph meningococcal information and

How to fill out MDPH Meningococcal Information and Waiver Form

1. Obtain the MDPH Meningococcal Information and Waiver Form from the appropriate website or institution.
2. Read the instructions carefully to understand the requirements of the form.
3. Fill out the personal information section, including your name, contact information, and date of birth.
4. Indicate whether you have received the meningococcal vaccine by checking the appropriate box.
5. If applicable, provide details about the vaccine, such as the date of vaccination and the type of vaccine received.
6. Read the waiver section carefully and understand the implications of signing it.
7. Sign and date the form in the designated area, confirming that all information provided is accurate.
8. Submit the completed form to the designated office or institution as instructed.

Who needs MDPH Meningococcal Information and Waiver Form?

1. Students entering college or universities that require meningococcal vaccination.
2. Individuals participating in certain programs or activities that recommend meningococcal vaccination.
3. Parents or guardians of minors who need to waive the vaccination requirement for their children.

People Also Ask about

Is meningococcal meningitis vaccine mandatory?

At least 34 states and the District of Columbia require some type of vaccination for students who are attending college or university classes. For example: At least 22 states require meningococcal vaccine, with most requiring meningococcal vaccine for students living on campus.

What is an immunization waiver?

All states allow exemptions from school immunization requirements for children who are unable to receive vaccines for medical reasons. State laws vary regarding non-medical exemptions, for religious or personal reasons. Personal exemptions are also referred to as "philosophical exemptions" by some states.

How can I be exempt from meningitis vaccine?

Exemption is permitted with proof of immunity, non-medical exemption or birth before 1957. First-time enrollees at California State University and University of California must show proof of hepatitis B vaccine. All institutions with on-campus housing must provide information about meningococcal ACWY and B.

Why not to get the meningococcal vaccine?

There may be times when someone shouldn't get a meningococcal vaccine, like if they: Had a life-threatening allergic reaction after the vaccine. Have a life-threatening allergy to any part of the vaccine.

Is meningococcal vaccine mandatory?

Key points. CDC recommends meningococcal vaccination for all adolescents. CDC also recommends meningococcal vaccination for children and adults at increased risk for meningococcal disease. Follow the recommended immunization schedule to ensure that your patients get the meningococcal vaccines that they need.

What does it mean to waive receipt of meningococcal vaccine?

Individuals 18 years of age and older may sign a written waiver choosing not to be vaccinated against meningococcal disease after reviewing the information on the risks of meningococcal disease, the availability of the vaccine, and effectiveness of the vaccine.

Can I get the meningitis vaccine for free?

Are free or low-cost meningococcal shots available? Yes, if you don't have insurance or your insurance does not cover the cost of the meningococcal vaccines, you may be able to find free or low-cost meningococcal shots. Note that there may still be an administration fee of up to $21.22 per shot.

What happens if I don't get the meningococcal vaccine?

Meningococcal disease is a very serious infection that can cause severe scarring, loss of limbs, brain damage and death. Vaccination is a safe and effective way to protect yourself from meningococcal disease.

For pdfFiller’s FAQs

What is MDPH Meningococcal Information and Waiver Form?

The MDPH Meningococcal Information and Waiver Form is a document required by the Massachusetts Department of Public Health that provides information about meningococcal disease and allows parents or guardians to waive the vaccination for their children under certain circumstances.

Who is required to file MDPH Meningococcal Information and Waiver Form?

Parents or guardians of students entering college or certain higher education institutions in Massachusetts are required to file the MDPH Meningococcal Information and Waiver Form.

How to fill out MDPH Meningococcal Information and Waiver Form?

To fill out the MDPH Meningococcal Information and Waiver Form, read the information provided about meningococcal disease, complete the required sections with the student's and guardian's information, and sign to indicate whether the vaccination will be accepted or waived.

What is the purpose of MDPH Meningococcal Information and Waiver Form?

The purpose of the MDPH Meningococcal Information and Waiver Form is to inform students and their families about the risks of meningococcal disease and to ensure compliance with state vaccination requirements while providing an option for waiving the vaccination.

What information must be reported on MDPH Meningococcal Information and Waiver Form?

The MDPH Meningococcal Information and Waiver Form must report the student’s full name, date of birth, college or institution name, vaccination status, and the guardian's acknowledgment of the risks associated with not receiving the vaccine.