Varicella declination form 2026

1. Click ‘Get Form’ to open the varicella declination form in the editor.
2. Begin by entering your personal information, including your name, phone number, and UCSD Employee ID. This ensures that your submission is properly tracked.
3. Review the vaccine information statement provided in the document. This section outlines the importance of vaccination and potential risks associated with varicella infection.
4. Choose one of the options regarding your participation in the Varicella vaccine program. Make sure to read each option carefully before making your selection.
5. If applicable, list any prior varicella vaccinations you have received along with their dates. This information is crucial for maintaining accurate health records.
6. Sign and date the form at the bottom to confirm your choices and understanding of the risks involved.
7. Finally, return the completed form to the Occupational Health Nurse via fax or mail as indicated in the instructions.

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