Get the free Hepatitis B Declination Statement - co.shasta.ca.us
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Hepatitis B Declination Statement The following statement of declination of hepatitis B vaccination must be signed by an employee who chooses not to accept the vaccine. I understand that by declining this vaccine I continue to be at risk of acquiring hepatitis B a serious disease. The statement is not a waiver employees can request and receive the hepatitis B vaccination at a later date if they remain occupationally at risk for hepatitis B. Declination Statement I understand that due to my...
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How to fill out hepatitis b declination statement
How to fill out hepatitis b declination statement
01
Read the hepatitis b declination statement carefully.
02
Fill out your personal information such as your name, date of birth, and contact information.
03
Understand the risks and benefits of getting the hepatitis b vaccine.
04
If you choose to decline the vaccine, write a statement stating your decision.
05
Sign and date the hepatitis b declination statement.
06
Submit the completed form to the relevant authority or healthcare provider.
Who needs hepatitis b declination statement?
01
Individuals who have already received the hepatitis b vaccine.
02
Those who have previously tested positive for hepatitis b and have developed immunity.
03
People who have documented medical contraindications to the vaccine.
04
Individuals who object to the vaccine based on religious or personal beliefs but are legally allowed to decline it.
05
Those who have completed the hepatitis b vaccine series.
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