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UNIVERSITY OF CALIFORNIA SAN FRANCISCO Office of Environmental Health and Safety POLIO EXPOSURE PROTOCOL FOR THE RESEARCH LABORATORY SETTING POLIO VACCINE DECLINATION FORM Vaccination of laboratory
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How to fill out polio vaccine declination form
How to fill out polio vaccine declination form:
01
Obtain the polio vaccine declination form from the relevant authority or organization.
02
Fill out the personal information section accurately, including your full name, date of birth, and contact information.
03
Provide the reason for declining the polio vaccine. This could be due to medical reasons or personal beliefs.
04
If applicable, attach any supporting documentation or medical notes that explain why you are declining the vaccine.
05
Read and understand any disclaimers or consequences associated with declining the polio vaccine, and sign and date the form accordingly.
06
Submit the completed form to the appropriate person or department as instructed.
Who needs polio vaccine declination form:
01
Individuals who have a medical condition or allergy that prevents them from receiving the polio vaccine may need a polio vaccine declination form.
02
Individuals with religious or personal beliefs that do not align with receiving the polio vaccine may also need to fill out this form.
03
Certain organizations or institutions may require individuals to fill out a polio vaccine declination form as part of their policy or requirements.
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What is polio vaccine declination form?
The polio vaccine declination form is a document that allows individuals to refuse receiving the polio vaccine for medical, religious, or personal reasons.
Who is required to file polio vaccine declination form?
Individuals who choose not to receive the polio vaccine are required to file the polio vaccine declination form.
How to fill out polio vaccine declination form?
To fill out the polio vaccine declination form, individuals must provide their personal information, reason for refusal, and signature confirming their decision.
What is the purpose of polio vaccine declination form?
The purpose of the polio vaccine declination form is to document that an individual has chosen not to receive the polio vaccine and understands the risks involved.
What information must be reported on polio vaccine declination form?
The polio vaccine declination form must include the individual's name, contact information, reason for refusal, and signature.
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