Get the free Meningococcal Disease Information and Waiver Form - vpul upenn

This document provides information about meningococcal disease, its risks, and the vaccination requirements for students living in campus housing at the University of Pennsylvania, including details

How to fill out meningococcal disease information and

How to fill out Meningococcal Disease Information and Waiver Form

1. Obtain the Meningococcal Disease Information and Waiver Form from your healthcare provider or school.
2. Read through the provided information about Meningococcal disease carefully.
3. Fill in the personal information section, including your name, date of birth, and contact details.
4. Review the vaccination history and indicate whether you have received the Meningococcal vaccine.
5. If applicable, provide the date of your last vaccination in the designated area.
6. Read the waiver statement thoroughly to understand your rights and responsibilities.
7. Sign and date the form to acknowledge your understanding and agreement with the content.
8. Submit the completed form to the appropriate authority, such as your school or healthcare provider.

Who needs Meningococcal Disease Information and Waiver Form?

1. Students entering college or university, as many institutions require proof of vaccination.
2. New residents in dormitory housing or communal living environments.
3. Individuals participating in certain health care or immunocompromised programs.
4. Anyone who has been advised by a healthcare provider to obtain meningococcal vaccination.

People Also Ask about

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

The meningococcal vaccine protects against meningococcal disease, a serious bacterial infection caused by Neisseria meningitidis. This infection can lead to meningitis, an inflammation of the tissues covering the brain and spinal cord. It can also cause bloodstream infections.

Who needs to get the meningococcal vaccine?

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 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.

When is too late for meningococcal vaccine?

Meningococcal vaccine schedule 11 to 12 years old, with a booster dose at 16 years old. 13 to 18 years old, if teens missed getting the shot at a younger age. Adolescents between 13 and 15 should get an additional booster dose between ages 16 to 18. Teens who get their first shot after 16 don't need a booster.

What is meningococcal disease fact sheet?

Meningococcal disease is a bacterial infection that can cause meningitis (inflammation of the brain and spinal cord covering), sepsis (blood infection), pneumonia (lung infection), or joint infections. Meningococcal disease can be quite severe and may result in brain damage, hearing loss, loss of limbs, or even death.

Can I get meningococcal if I'm vaccinated?

Because routine childhood vaccines do not protect against all strains of meningococcal disease, all people must still be alert for the symptoms and signs of meningococcal disease, even if they have been vaccinated.

Is meningococcal vaccine necessary?

CDC recommends meningococcal vaccination for all preteens and teens, as well as other children and adults at increased risk. Meningococcal vaccines are the best way to protect against meningococcal disease, but side effects can occur. Talk to a vaccine provider if you have questions about meningococcal vaccines.

Do I need a script for meningococcal vaccine?

Persons eligible for the free vaccine can visit their local council, general practitioner (GP) or pharmacy to receive the free vaccine. If you are not eligible for the free vaccine but wish to reduce your risk of meningococcal disease, you can purchase the vaccine on prescription.

For pdfFiller’s FAQs

What is Meningococcal Disease Information and Waiver Form?

The Meningococcal Disease Information and Waiver Form is a document designed to inform individuals about meningococcal disease, its risks, and vaccination options. It also allows individuals to waive their right to receive the vaccination if they choose not to.

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

Individuals entering college or certain educational institutions, particularly those living in on-campus housing, are typically required to file the Meningococcal Disease Information and Waiver Form.

How to fill out Meningococcal Disease Information and Waiver Form?

To fill out the form, individuals must provide personal information, review the information about meningococcal disease and vaccination, indicate their choice regarding vaccination, sign the document, and submit it to the appropriate institution.

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

The purpose of the form is to ensure that individuals are adequately informed about meningococcal disease and to document their choice regarding vaccination, either accepting or declining the vaccination.

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

The form must typically report the individual's name, date of birth, contact information, vaccination history, and whether the individual chooses to receive the vaccination or waive it.