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Date / / Meningococcal Vaccine Declination Form Student Health Services LOCATION 200 Georgia Ave. PHONE 229.333.5886 FAX ADDRESS 1500 N. Patterson St. Valdosta, GA 316980175 229.249.2791 WEB www.valdosta.edu/healthACCEPTED

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How to fill out meningococcal vaccine declination

01

Here are the steps to fill out a meningococcal vaccine declination form: 1. Obtain a copy of the declination form from your healthcare provider.

02

Read the instructions and information provided on the form.

03

Provide your personal details such as name, date of birth, and contact information.

04

Indicate the reason for declining the meningococcal vaccine. This may include medical contraindications or personal beliefs.

05

Sign and date the form to acknowledge your decision to decline the vaccine.

06

Return the completed form to your healthcare provider.

Who needs meningococcal vaccine declination?

01

Meningococcal vaccine declination is typically required for individuals who have a medical contraindication to the vaccine. This may include individuals with severe allergies to vaccine components or those with a history of Guillain-Barré syndrome.

02

Additionally, some individuals may choose to decline the meningococcal vaccine for personal or religious beliefs, in which case, they would also need to fill out a meningococcal vaccine declination form.

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What is meningococcal vaccine declination?

Meningococcal vaccine declination is the act of refusing to receive the meningococcal vaccine.

Who is required to file meningococcal vaccine declination?

Individuals who choose not to receive the meningococcal vaccine are required to file a declination form.

How to fill out meningococcal vaccine declination?

To fill out the meningococcal vaccine declination form, individuals must provide their personal information and reason for declining the vaccine.

What is the purpose of meningococcal vaccine declination?

The purpose of meningococcal vaccine declination is to document an individual's decision to not receive the vaccine for health or personal reasons.

What information must be reported on meningococcal vaccine declination?

The meningococcal vaccine declination form must include the individual's name, date of birth, reason for declining the vaccine, and signature.

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