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Hepatitis b vaccine consent form cdc

Hepatitis b vaccine documentation form 2025

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The document is a Hepatitis B Virus (HBV) Vaccine Acceptance or Declination Form from The University of Texas Health Science Center at San Antonio. It provides employees with the option to accept or decline the HBV vaccine offered at no cost, detailing the risks associated with occupational exposure to blood and infectious materials. The form requires employee and supervisor signatures and emphasizes the importance of reporting for vaccination within 10 working days if accepted. It also notes that a copy of the document should be retained in the employee's medical record for 30 years after employment termination.

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Click ‘Get Form’ to open the hepatitis B vaccine documentation form in the editor.
Begin by filling out the Acceptance Statement if you choose to receive the vaccine. Enter your printed name and department in the designated fields.
Sign the form where indicated, and provide your HSC Badge Number. Ensure that your supervisor or witness also signs and dates the form.
If you decide to decline the vaccine, complete the Declination Statement. Again, fill in your printed name and department, sign, and include your HSC Badge Number.
Make sure all sections are completed accurately before saving or exporting your document for record-keeping.

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What additional information needs to be documented when administering a vaccine?

What information does federal law require us to document when we immunize a patient? The vaccine manufacturer. The lot number of the vaccine. The date the vaccine is administered. The name, office address, and title of the healthcare provider administering the vaccine.

What constitutes sufficient documentation for vaccine counseling?

For example, documentation should list all vaccine components along with a notation such as counseling for all components completed. The documentation format (eg, checkbox, handwritten, electronic template) for this service should be the same as for other services.

How to prove hep B vaccination?

Testing for evidence of immunity after vaccination is not routinely recommended, except those in certain groups. In those at risk of occupational exposure, particularly healthcare and laboratory workers, antibody levels should be checked one to two months after the completion of the full vaccination course.

What is the Hep B vaccine note?

Immunization against hepatitis B disease is recommended for all newborn babies, infants, children, and adolescents up to 19 years of age. It is also recommended for adults who live in areas that have a high rate of hepatitis B disease or who may be at increased risk of infection from hepatitis B virus.

What are 8 details that must be documented when a vaccination is given?

Immunization providers are required by law to record what vaccine was given, the date the vaccine was given (month, day, year), the name of the manufacturer of the vaccine, the lot number, the signature and title of the person who gave the vaccine, and the address where the vaccine was given.

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What is an example of proof of vaccination?

A record from a healthcare providers medical record system (including a patient portal) that is either a: Vaccine Administration Record from the facility where the vaccine was administered that includes the: Vaccine administered. Vaccination date.

What is required documentation when giving a vaccine?

The National Childhood Vaccine Injury Act requires that a VIS must be given to parents, legal representatives, or adult patients before administering the vaccine. A VIS must be provided prior to each dose, not just the first dose. Providers should be sure they are using the most current version of each VIS.

What needs documented when giving a vaccine?

By law, the following information must be documented on the patients paper or electronic medical record (or on a permanent office log): The vaccine manufacturer. The lot number of the vaccine. The date the vaccine is administered.