Get Hepatitis B Immunization Form - Illinois College Of Optometry

Completing the Hepatitis B Immunization Form for the Illinois College of Optometry is an important step in ensuring your health and safety. This guide provides clear, step-by-step instructions for filling out the form online, ensuring that you provide all necessary information accurately.

Follow the steps to effectively complete the immunization form online.

1. Press the ‘Get Form’ button to access the Hepatitis B Immunization Form and open it in your preferred editor.
2. In the first section, enter your full name in the space provided for NAME (PRINT), ensuring it matches your identification documents.
3. Next, input your Social Security Number (SSN) in the designated field, as this information is required for identification purposes.
4. In the section stating 'It is my opinion that...', the health care provider must fill in their assessment regarding your suitability to receive the Hepatitis B vaccine.
5. The physician or primary health care provider must then provide their signature to confirm their opinion about your ability to receive the vaccine.
6. Enter the date when the physician's opinion is rendered, ensuring the format is consistent with the requirements of the form.
7. In the consent section, you will affirm your agreement to receive the HBV vaccine. Carefully read the liability waiver and then provide your signature.
8. A witness to your signature must also sign the form, providing their confirmation of your consent.
9. Include the date of witnessing the signature in the appropriate field.
10. Fill in the site of vaccination and the lot number as provided by the administering personnel.
11. Have the individual(s) administering the vaccine sign in the designated spaces, ensuring their credentials are noted as required.
12. Once all fields are completed, you may save changes, download, print, or share the form as needed.

Complete your Hepatitis B Immunization Form online today to ensure your health needs are met.