Fws 3 2283-2026

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The document is a Hepatitis B Immunization Consent/Refusal Form that allows individuals to either consent to or decline the Hepatitis B vaccine. It outlines the vaccination process, potential risks, and the importance of vaccination for those at risk due to occupational exposure. The form includes sections for personal information, signatures, and a Privacy Act Statement regarding the handling of sensitive information.

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Click ‘Get Form’ to open the fws 3 2283 in the editor.
Begin by selecting your preference regarding the Hepatitis B vaccine. Check 'Yes' if you wish to receive it, and ensure you read the provided information thoroughly.
If you choose 'Yes', fill in the date given, lot number, and the name of the administrator. Record the next due date for each of the three doses.
If you opt for 'No', acknowledge your understanding of the risks associated with declining vaccination by signing and dating the form.
Complete your personal details including your name, city, state, zip code, telephone number, facility name, and address.
Finally, review all entries for accuracy before saving or exporting your completed form.

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