Stanford University Hepatitis B Vaccine Declaration Form 2017-2025 free printable template

HEPATITIS B VACCINE DECLARATION FORM Name (Last, First, MI) Email Daytime Phone(s) Employee ID Number Job Title Sunset ID Department Date of Birth (mm/dd/by) Supervisor/PI Name Stanford Work Location

How to fill out Stanford University Hepatitis B Vaccine Declaration

How to fill out Stanford University Hepatitis B Vaccine Declaration Form

1. Obtain the Stanford University Hepatitis B Vaccine Declaration Form from the university's health services or website.
2. Read the instructions carefully to understand the requirements.
3. Fill in your personal information, including your name, student ID, and contact details.
4. Indicate whether you have completed the Hepatitis B vaccination series by checking the appropriate box.
5. If you have been vaccinated, provide the dates of your vaccinations in the designated section.
6. If you have not been vaccinated, select the option for declining the vaccination and provide a reason, if necessary.
7. Sign and date the form to validate your declaration.
8. Submit the completed form to the appropriate office, such as the student health center or through the online submission portal.

Who needs Stanford University Hepatitis B Vaccine Declaration Form?

1. Any incoming students, including undergraduates and graduates, who will be residing in university housing or are involved in certain health-related programs at Stanford University.

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What is Stanford University Hepatitis B Vaccine Declaration Form?

The Stanford University Hepatitis B Vaccine Declaration Form is a document that requires individuals to declare their vaccination status against Hepatitis B.

Who is required to file Stanford University Hepatitis B Vaccine Declaration Form?

Individuals who are at risk of exposure to Hepatitis B, such as students in health-related programs and certain employees, are required to file this form.

How to fill out Stanford University Hepatitis B Vaccine Declaration Form?

To fill out the form, individuals should provide personal information, indicate their vaccination status, and possibly submit evidence of vaccination or a medical exemption if applicable.

What is the purpose of Stanford University Hepatitis B Vaccine Declaration Form?

The purpose of the form is to ensure that individuals who are at risk of Hepatitis B are either vaccinated or have a documented exemption, thereby promoting health and safety.

What information must be reported on Stanford University Hepatitis B Vaccine Declaration Form?

The form typically requires information such as personal details (name, date of birth), vaccination history (dates of Hepatitis B vaccination), and any applicable medical exceptions.