Get the free Hepatitis B Declination Statement - kbcc cuny

GAINSBOROUGH COMMUNITY COLLEGE The City University of New York Office of Health Services DECLINATION STATEMENT I understand that due to my occupational exposure to blood or other potentially infectious

How to fill out hepatitis b declination statement

How to fill out a hepatitis B declination statement:

1. Obtain the hepatitis B declination statement form from your employer or healthcare provider. This form is typically used in healthcare settings or occupations where there is a risk of exposure to blood or bodily fluids.
2. Read the form carefully and understand the purpose and implications of declining hepatitis B vaccination. The form may include information about the risks of hepatitis B, the benefits of vaccination, and the potential consequences of declining vaccination.
3. Fill in your personal information, including your full name, date of birth, and contact details. Make sure all the information is accurate and up-to-date.
4. Review and understand the statement section of the form. This section usually includes a statement acknowledging that you have been offered the hepatitis B vaccine, that you understand the risks and benefits of the vaccination, and that you are declining it voluntarily.
5. Sign and date the declination statement. By signing the form, you are indicating that you have made an informed decision to decline the hepatitis B vaccination and assume any potential risks associated with it.

Who needs a hepatitis B declination statement:

1. Healthcare workers: Doctors, nurses, laboratory technicians, and other healthcare professionals who may come into contact with blood or bodily fluids are often required to fill out a hepatitis B declination statement. This is to ensure they have considered the risks and benefits of vaccination and made an informed decision.
2. Students in healthcare programs: Some educational institutions require students enrolled in healthcare programs, such as nursing or medical school, to provide a hepatitis B declination statement. This is to ensure the students have assessed their own risk factors and made an informed choice regarding vaccination.
3. Occupations with potential exposure to blood or bodily fluids: Certain occupations outside of healthcare, such as emergency responders, law enforcement, and laboratory staff, may also require a hepatitis B declination statement. These individuals may encounter situations where they could be exposed to hepatitis B, and the form ensures they have acknowledged the risks and chosen to decline vaccination.

It's important to note that the specific requirements for a hepatitis B declination statement may vary depending on the organization or employer. If you are unsure whether you need to fill out a declination statement, it is best to consult with your employer or healthcare provider.

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