Download EASTERN MICHIGAN UNIVERSITY HEPATITIS B VACCINATION DECLINATION FORM

Survey
yes no Was this document useful for you?
   Thank you for your participation!

* Your assessment is very important for improving the work of artificial intelligence, which forms the content of this project

Document related concepts

Common cold wikipedia, lookup

Germ theory of disease wikipedia, lookup

Sociality and disease transmission wikipedia, lookup

Neonatal infection wikipedia, lookup

Hygiene hypothesis wikipedia, lookup

Globalization and disease wikipedia, lookup

Herd immunity wikipedia, lookup

Infection wikipedia, lookup

Eradication of infectious diseases wikipedia, lookup

Transmission (medicine) wikipedia, lookup

Immunocontraception wikipedia, lookup

Whooping cough wikipedia, lookup

Infection control wikipedia, lookup

Hepatitis wikipedia, lookup

Vaccine wikipedia, lookup

Vaccination policy wikipedia, lookup

Childhood immunizations in the United States wikipedia, lookup

Hepatitis C wikipedia, lookup

Vaccination wikipedia, lookup

Hepatitis B wikipedia, lookup

Transcript
EASTERN MICHIGAN UNIVERSITY
HEPATITIS B VACCINATION DECLINATION FORM
I understand that due to my occupational exposure to blood or other potentially infectious materials,
I may be at risk of acquiring hepatitis B virus (HBV) infection. I have been given the opportunity to be
vaccinated with hepatitis B vaccine, at no charge to myself.
However, I decline hepatitis B
vaccination at this time. I understand that by declining this vaccine, I continue to be at risk of
acquiring hepatitis B, a serious disease. If in the future I continue to have occupational exposure to
blood or other potentially infectious materials and I want to be vaccinated with hepatitis B vaccine, I
can receive the vaccination series at no charge to me.
Employee Name (print): _________________________________
Employee Signature:
_________________________________
Dated the _____day of the month of __________________, 20__
EMUDPS-EHS-f032
Rev. 1