Get the free Declination of Varicella Vaccination

This document serves as a formal declaration by an employee declining the Varicella (chicken pox) vaccination, acknowledging the risks associated with not being vaccinated while working in a healthcare environment.

How to fill out declination of varicella vaccination

How to fill out declination of varicella vaccination

1. Obtain the declination form from your healthcare provider or school.
2. Read the instructions on the form carefully.
3. Fill in your personal information, including your name, date of birth, and contact information.
4. Indicate your reasons for declining the varicella vaccination, ensuring to specify any relevant medical, religious, or personal beliefs.
5. Sign and date the form to certify that the information provided is accurate.
6. Submit the completed form to the appropriate institution, such as your healthcare provider, school, or daycare.

Who needs declination of varicella vaccination?

1. Parents or guardians of children who are required to receive the varicella vaccination but choose to decline it.
2. Adults who are in environments that require proof of varicella vaccination but wish to opt-out for specific reasons.
3. Individuals with contraindications to vaccination, or those following religious or philosophical beliefs that oppose vaccination.

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What is declination of varicella vaccination?

Declination of varicella vaccination refers to a formal statement made by a parent or guardian opting not to have their child vaccinated against the varicella virus (chickenpox), usually for personal, philosophical, or medical reasons.

Who is required to file declination of varicella vaccination?

Parents or guardians of children who are attending school or child care facilities and choose not to have their children vaccinated against varicella are required to file a declination.

How to fill out declination of varicella vaccination?

To fill out a declination of varicella vaccination, the parent or guardian should obtain the appropriate form from their local health department or school, provide necessary personal information, clearly indicate their decision to decline vaccination, and sign and date the form.

What is the purpose of declination of varicella vaccination?

The purpose of filing a declination of varicella vaccination is to formally document a parent's or guardian's choice not to immunize their child, ensuring compliance with state or local health requirements.

What information must be reported on declination of varicella vaccination?

The declination form must typically include the child's name, date of birth, the name of the parent or guardian, the reason for declining the vaccination, and a signature affirming the decision.