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Org http //www. uwhealth. org/vendors Phone 890-8505 Fax 890-8507 HEPATITIS B VACCINE DECLINE TO ACCEPT FORM I understand that due to my occupational exposure to blood or other potentially infectious materials I may be at risk of acquiring Hepatitis B virus HBV infection. It has been recommended that I be vaccinated with Hepatitis B vaccine at my expense or at the expense of my employer.

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How to fill out hepatitis b decline to

How to fill out hepatitis b decline to:

01

Obtain the hepatitis b decline to form from a healthcare provider or the appropriate institution.

02

Read through the form thoroughly to understand the purpose and requirements.

03

Fill in your personal information accurately, including your full name, date of birth, and contact information.

04

Provide information about your healthcare provider or institution, such as their name, address, and contact details.

05

Check the box that indicates your refusal to receive the hepatitis b vaccine or any related treatment.

06

Sign and date the form to acknowledge your decision.

07

Submit the completed form to the healthcare provider or institution as per their instructions.

Who needs hepatitis b decline to:

01

Individuals who have made an informed decision to decline the hepatitis b vaccine or any related treatment.

02

Those who have valid medical, religious, or personal reasons for refusing the vaccine.

03

People who have consulted with their healthcare provider and received advice or recommendations regarding their decision to decline the vaccination.

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