Get the free MDPH Meningococcal Information and Waiver Form - umassd

This document provides essential information regarding meningococcal disease, its risks, the vaccination requirement for students living in dormitories or congregate housing, and the option to sign

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 health department or website.
2. Fill in the personal information section including your name, date of birth, and contact information.
3. Review the section regarding meningococcal disease and its prevention.
4. Indicate whether you have received the meningococcal vaccine by checking the appropriate box.
5. If you are waiving the vaccine, provide a reason in the designated section.
6. Sign and date the form to confirm the information is accurate and that you understand the waiver.
7. Submit the completed form to your school or the required health agency.

Who needs MDPH Meningococcal Information and Waiver Form?

1. Students entering college or university who are required to provide proof of vaccination.
2. Individuals living in dormitories or close quarters.
3. Parents or guardians of minors who need to complete the form for school enrollment.
4. Anyone who is advised by a healthcare provider to consider vaccination for meningococcal disease.

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 regarding meningococcal disease and allows parents or guardians to either consent to or waive the vaccination for their children.

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

Parents or guardians of students who are entering 11th grade or are new to a Massachusetts college or university 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, you need to provide your child's information, review the meningococcal disease information provided in the form, and then either sign to consent for vaccination or indicate a waiver.

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

The purpose of the MDPH Meningococcal Information and Waiver Form is to educate parents about the risks of meningococcal disease and to obtain consent for vaccination or document a waiver for students.

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

The MDPH Meningococcal Information and Waiver Form must report the student's name, date of birth, school, immunization history, and either the signature of the parent or guardian to consent to vaccination or to indicate a waiver.