Get the free Hepatitis B Vaccine or Declination Form

This form is for University of Utah employees to indicate their desire to receive the Hepatitis B vaccine or to decline vaccination, acknowledging the risks associated with occupational exposure to

How to fill out hepatitis b vaccine or

How to fill out Hepatitis B Vaccine or Declination Form

1. Obtain the Hepatitis B Vaccine or Declination Form from your healthcare provider or workplace.
2. Fill in your personal details such as your name, date of birth, and employee ID if applicable.
3. Indicate whether you choose to receive the Hepatitis B vaccine or decline the vaccine.
4. If choosing to receive the vaccine, provide any necessary medical history or information requested.
5. Sign and date the form to certify your decision and understanding of the risks.
6. Submit the completed form to the designated person or department as instructed.

Who needs Hepatitis B Vaccine or Declination Form?

1. Healthcare workers who may be exposed to blood or bodily fluids.
2. Students in healthcare-related programs.
3. Individuals who are at risk due to occupational exposure.
4. Persons working in laboratories or research facilities handling blood products.

People Also Ask about

What is a declination form?

​A coverage declination form is a document that agencies should use as part of their workflow process for situations when a client declines coverage. The client signs the form to acknowledge that they reviewed the coverage with their agent and that they are declining to purchase coverage.

What if an employee declines to be vaccinated for hepatitis B?

If an individual is offered the Hepatitis B vaccination series and declines it, the person must file a declination form.

Why do people not want the Hep B vaccine?

The most common reason for refusal was “my baby is too young” (78.1%), followed by “I don't think my child is at risk for hepatitis B” (43.8%). “Concerns regarding the safety of the vaccine” was the most common answer given for why participants refused vaccination (70.4%).

Do you accept or decline the hepatitis B vaccination?

Although your employer must offer the vaccine to you, you do not have to accept that offer. You may opt to decline the vaccination series, in which case you will be asked to sign a declination form (see Hepatitis B Vaccination Agreement/Refusal Form).

Do I really need the hepatitis B vaccine?

Sometimes hepatitis B virus stays in your body for years (chronic hepatitis B virus infection) leading to liver damage, liver cancer, and death. The Centers for Disease Control and Prevention (CDC) recommends everyone from birth up to age 60 years get hepatitis B vaccination.

When you wish to decline the vaccination for hepatitis B you must?

If the employee declines, then the signed declination form must be in the record. The easiest method to document properly why the hepatitis B vaccination was not given is simply to have the employee sign the declination form regardless of the reason.

What is a vaccine declination?

document the refusal of one or more recommended immunizations.

Should I decline a Hep B vaccine?

If someone offers you the vaccine declination form, whether you decide to accept the hepatitis B vaccine is your decision. However, there are benefits to having the vaccine — it's usually safe and can prevent you from developing hepatitis B and potentially more serious conditions as a result.

For pdfFiller’s FAQs

What is Hepatitis B Vaccine or Declination Form?

The Hepatitis B Vaccine or Declination Form is a document used to record an individual's choice to either receive the Hepatitis B vaccine or to decline vaccination. This form is often required in occupational settings, particularly in healthcare, to ensure awareness and compliance with safety regulations.

Who is required to file Hepatitis B Vaccine or Declination Form?

Individuals who are at risk of exposure to Hepatitis B virus, particularly healthcare workers and others who may come into contact with blood or bodily fluids, are required to file the Hepatitis B Vaccine or Declination Form.

How to fill out Hepatitis B Vaccine or Declination Form?

To fill out the Hepatitis B Vaccine or Declination Form, individuals should provide personal information, indicate their choice regarding vaccination, and sign the document. If declining, individuals may be asked to provide a reason for their declination.

What is the purpose of Hepatitis B Vaccine or Declination Form?

The purpose of the Hepatitis B Vaccine or Declination Form is to document an individual's vaccination status and choices regarding the Hepatitis B vaccine, ensuring safety and compliance with public health and occupational safety regulations.

What information must be reported on Hepatitis B Vaccine or Declination Form?

The Hepatitis B Vaccine or Declination Form typically requires personal information such as name, date of birth, and job title, as well as the individual's vaccination status, signature, and date of signing.