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GOVERNMENT OF THE DISTRICT OF COLUMBIA DEPARTMENT OF HEALTH Human Papillomavirus (HPV) Vaccination Opt-out Certificate INSTRUCTIONS FOR COMPLETING THIS FORM Section 1: Enter student information. Section

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What is hpv vaccine refusal form?

The HPV vaccine refusal form is a document that allows individuals to decline or refuse the HPV vaccine for themselves or their minor children.

Who is required to file hpv vaccine refusal form?

Individuals or parents/guardians who do not wish to receive the HPV vaccine or have their minor children receive it are required to file the HPV vaccine refusal form.

How to fill out hpv vaccine refusal form?

To fill out the HPV vaccine refusal form, individuals or parents/guardians need to provide their personal information, such as name, contact information, and the names of the individuals for whom they are refusing the vaccine. They may also need to indicate the reason for their refusal.

What is the purpose of hpv vaccine refusal form?

The purpose of the HPV vaccine refusal form is to inform healthcare providers and relevant authorities that an individual or their minor children will not be receiving the HPV vaccine despite its recommended or required status.

What information must be reported on hpv vaccine refusal form?

The HPV vaccine refusal form usually requires the reporting of personal information, such as the individual's or minor child's name, contact information, and date of birth. It may also request the reason for the refusal.

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