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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 retaining a copy in the employee's medical record for 30 years after termination.

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Click ‘Get Form’ to open the hepatitis B vaccine documentation form in the editor.
Begin with the Acceptance Statement section. Here, print your name and department in the designated fields.
Sign the form where indicated as the employee, and enter your HSC Badge Number.
Have your supervisor or witness sign and date the form to complete this section.
If you choose to decline the vaccine, navigate to the Declination Statement. Fill in your name and department again.
Sign as the employee, provide your HSC Badge Number, and ensure a supervisor or witness signs and dates this section as well.
Review all entries for accuracy before saving or exporting your completed document.

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2009	4.9 Satisfied (46 Votes)

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What is a declination form for the hepatitis B vaccine?

A hepatitis B declination form is a form your employer may give you to offer you the hepatitis B vaccine option due to the occupational risk of exposure to the virus.

What must be documented after 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.

What to document when giving an injection?

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.

What information is needed when documenting immunizations?

Documentation is for the correct beneficiary and date of service. Documentation includes physicians order for date(s) of service when medication(s) were administered, to include the medication name, dosage, frequency, and method of administration.

What is the full form of the hepatitis B vaccine?

What is a hepatitis B vaccine? A hepatitis B vaccine prevents hepatitis B virus infection (HBV). Engerix-B, Heplisav-B, and Recombivax HB (all brand names) are examples of hepatitis B vaccines approved by the U.S. Food and Drug Administration (FDA).

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What is the doc for hepatitis B?

Doctors who specialize in treating hepatitis B include: Doctors called gastroenterologists, who treat digestive diseases. Doctors called hepatologists, who treat liver diseases. Doctors who treat infectious diseases.

Hepatitis b vaccine documentation form 2025

Here's how it works

How to use or fill out hepatitis b vaccine documentation form with our platform

See more hepatitis b vaccine documentation form versions

Complete this form in 5 minutes or less

Got questions?

What is a declination form for the hepatitis B vaccine?

What must be documented after giving a vaccine?

What to document when giving an injection?

What information is needed when documenting immunizations?

What is the full form of the hepatitis B vaccine?

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What is the doc for hepatitis B?

hep b vaccine consent form

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