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Hepatitis b vaccine consent form cdc

Hepatitis b vaccine documentation form 2026

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4.9 out of 5

46 votes

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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2009	4.9 Satisfied (46 Votes)

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