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Applicant Name Applicant Signature Date / / PURE MEDICAL STAFFING HEPATITIS B DECLINATION PAGE 1 of 1. I fully understand the OSHA guidelines in the publication regarding the prevention measures for Hepatitis B. HEPATITIS B DECLINATION DECLINATION STATEMENT I am signing the following statement of declination of the Hepatitis B vaccination because I choose not to accept the vaccine. I have received appropriate training regarding Hepatitis B Hepatitis B vaccination the efficacy safety method of...
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Start by obtaining the declination statement form from puremedstaffcom or their authorized representative.
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Read and understand the instructions provided with the form.
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Fill out your personal information including your full name, address, date of birth, and contact details.
04
Clearly state your decision to decline a specific service, treatment, procedure, or recommendation.
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Provide a detailed reason for your decision, if required.
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Anyone who has been recommended or offered a service, treatment, or procedure by puremedstaffcom.
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Patients who have received sufficient information about the recommended service, treatment, or procedure and have made an informed decision to decline it.
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People who want to exercise their right to refuse medical interventions.
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Anyone who wants to protect their autonomy and make choices regarding their own healthcare.
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