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A form for students and their guardians at the University of Colorado Colorado Springs to acknowledge understanding of the health risks associated with meningococcal disease and to waive vaccination
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How to fill out acknowledgment of receipt of
How to fill out Acknowledgment of Receipt of Information/Waiver of Immunization against Meningococcal Disease
01
Obtain the Acknowledgment of Receipt of Information/Waiver form from your institution or health provider.
02
Read through the information provided on the form regarding meningococcal disease and the vaccine.
03
Fill in your personal details such as name, date of birth, and contact information in the designated fields.
04
Indicate your decision regarding the immunization by checking the appropriate box (either opting for vaccination or waiving the vaccine).
05
If you choose to waive the immunization, you may need to provide a brief explanation or reason for your decision.
06
Sign and date the form to confirm that you understand the information presented and your choice regarding the vaccine.
07
Submit the completed form to the appropriate office at your school or health provider.
Who needs Acknowledgment of Receipt of Information/Waiver of Immunization against Meningococcal Disease?
01
Students attending college or university who are not vaccinated against meningococcal disease.
02
Individuals required by their educational institution to show proof of immunization or a waiver.
03
New students or transfer students who need to comply with health regulations upon enrollment.
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People Also Ask about
What happens if you don't get the meningococcal vaccine?
It is recommended for all kids and teens age 11 and older. Some types of MenACWY are given to younger children (as early as 8 weeks of age) if they have a higher risk of getting meningococcal disease. The meningococcal B vaccine (MenB) protects against a fifth type of meningococcal bacterium (called type B).
Do kids really need meningococcal vaccines?
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.
Should my child get the meningococcal B vaccine?
There are increasing cases of injuries caused by the meningitis vaccine. Although the dangers of the meningitis vaccine differ, the most common vaccine effect is shoulder injury related to vaccine administration (SIRVA). SIRVA is an adverse reaction when a healthcare provider administers the vaccine improperly.
How can I be exempt from meningitis vaccine?
Exemptions: Students may begin classes without a certificate of immunization against meningococcal disease if: 1) the student has a letter from a physician stating that there is a medical reason why he/she can't receive the vaccine; 2) the student (or the student's parent or legal guardian, if the student is a minor)
Is the meningococcal vaccine necessary?
What happens if you don't have meningococcal vaccine? You could get meningococcal disease, which is a very serious, life-threatening condition. SOURCES: National Meningitis Association: "About Meningococcal Disease."
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.
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What is Acknowledgment of Receipt of Information/Waiver of Immunization against Meningococcal Disease?
It is a form that documents a person's acknowledgment of receiving information regarding the meningococcal disease vaccine and allows them to waive the vaccination under certain circumstances.
Who is required to file Acknowledgment of Receipt of Information/Waiver of Immunization against Meningococcal Disease?
Typically, this form is required to be filed by students, particularly those entering college or university, who are opting not to receive the meningococcal vaccine after being informed about its benefits and risks.
How to fill out Acknowledgment of Receipt of Information/Waiver of Immunization against Meningococcal Disease?
To fill out the form, individuals must provide personal information such as their name, date of birth, and contact details, indicate their choice regarding the vaccine, and sign the document to acknowledge their decision.
What is the purpose of Acknowledgment of Receipt of Information/Waiver of Immunization against Meningococcal Disease?
The purpose is to ensure that individuals are informed about the risks associated with meningococcal disease and the benefits of vaccination before they make a conscious decision to waive the immunization.
What information must be reported on Acknowledgment of Receipt of Information/Waiver of Immunization against Meningococcal Disease?
The form typically requires information such as the individual's full name, date of birth, the date of the acknowledgment, and the signature of the individual or their parent/guardian if applicable.
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