Get the free MDPH Meningococcal Information and Waiver Form - fitchburgstate

This document provides information regarding meningococcal disease, vaccination requirements for students at residential schools and colleges in Massachusetts, and a waiver form for students who choose

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 official website or a healthcare provider.
2. Read through the form carefully to understand the information required.
3. Fill out the personal information section, including the name, date of birth, and contact details.
4. Indicate your vaccination status by checking the appropriate box regarding meningococcal vaccination.
5. Provide any additional required medical information, if applicable.
6. Review the waiver section, and if you choose to waive the vaccine, ensure that you understand the implications.
7. Sign and date the form to certify that the information provided is accurate.
8. Submit the completed form as instructed, either by mail or in person.

Who needs MDPH Meningococcal Information and Waiver Form?

1. Individuals pursuing higher education at institutions that require proof of meningococcal vaccination.
2. Students living in dormitories or residential facilities.
3. Individuals participating in certain programs or activities where meningococcal vaccination is recommended.
4. Parents or guardians filling out the form on behalf of minors.

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 utilized by the Massachusetts Department of Public Health (MDPH) to collect information regarding meningococcal vaccination status and to provide a waiver for individuals who choose not to be vaccinated.

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

The form is required to be filed by students residing in Massachusetts who are entering a post-secondary educational institution and are under the age of 21, as they must provide proof of meningococcal vaccination or a signed waiver.

How to fill out MDPH Meningococcal Information and Waiver Form?

To fill out the form, individuals must complete sections that include personal information, vaccination history, and consent or waiver statements. Ensure that all sections are accurately filled and that signatures are provided where necessary.

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

The purpose of the form is to inform students about the risks associated with meningococcal disease, to confirm their vaccination status, and to document their decision to waive the vaccination if they choose not to get vaccinated.

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

The form requires reporting of personal identification information, details regarding meningococcal vaccination (such as date and type of vaccine), and a signed statement indicating whether the student is opting for the vaccination or waiving it.