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UNM EMPLOYEE OCCUPATIONAL HEALTH
TETANUS AND DIPHTHERIA OR TETANUS, DIPHTHERIA and PERTUSSIS
VACCINE DECLINATION
I understand that tetanus, also called lockjaw, is a life-threatening infection acquired
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How to fill out tetanus declination form
How to fill out a tetanus declination form?
01
Begin by obtaining a copy of the tetanus declination form from a healthcare provider or the organization requiring it.
02
Read the instructions carefully to ensure you understand the purpose and requirements of the form.
03
Fill in your personal information, such as your name, date of birth, and contact details, in the designated fields.
04
Provide information about your healthcare provider, including their name, contact information, and any relevant medical history.
05
Indicate the reason for declining the tetanus vaccination. This may include a previous vaccination, medical contraindication, or personal beliefs.
06
Sign and date the form to confirm that the information provided is accurate to the best of your knowledge.
07
Submit the completed form to the relevant authority or organization as instructed.
Who needs a tetanus declination form?
01
Individuals who have previously received a tetanus vaccination may need to complete a tetanus declination form to opt out of getting the vaccine again.
02
Those with medical contraindications, such as a severe allergic reaction to tetanus vaccines or specific health conditions, may require a tetanus declination form.
03
Individuals who have personal or religious beliefs that prevent them from receiving certain vaccinations, including tetanus, may also need to fill out a declination form.
It is important to note that the specific requirements for a tetanus declination form may vary depending on the healthcare provider, organization, or jurisdiction. Therefore, it is essential to follow the instructions provided with the form and consult with a healthcare professional if you have any questions or concerns.
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What is tetanus declination form?
Tetanus declination form is a document used to indicate that an individual has declined to receive the tetanus vaccine.
Who is required to file tetanus declination form?
Individuals who have been offered the tetanus vaccine but have chosen to decline it are required to file the tetanus declination form.
How to fill out tetanus declination form?
The tetanus declination form typically requires the individual to provide their personal information, reason for declining the vaccine, and signature to indicate their decision.
What is the purpose of tetanus declination form?
The purpose of the tetanus declination form is to document an individual's decision to decline the tetanus vaccine and acknowledge the risks associated with not receiving the vaccine.
What information must be reported on tetanus declination form?
The tetanus declination form may require the individual's name, date of birth, address, reason for declining the vaccine, and signature.
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