HEPATITIS B VACCINE DECLARATION FORM Name (Last, First, MI) Email Daytime Phone(s) Employee ID Number Job Title SUNet ID Department Date of Birth (mm/dd/yy) Supervisor/PI Name Stanford Work Location.
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How to fill out the Hepatitis Declaration Form State Of California online
The Hepatitis Declaration Form is an important document for individuals exposed to blood or infectious materials in California. This guide will provide you with clear, step-by-step instructions on how to complete the form online to ensure accurate and timely submissions.
Follow the steps to complete your Hepatitis Declaration Form online.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Fill in your personal details, including your name (last, first, middle initial), employee ID number, SUNet ID, date of birth, email address, job title, department, supervisor or PI name, and daytime phone number.
- Indicate your employment status by selecting the appropriate box from the options provided, including roles such as faculty, staff, employed student, medical student, volunteer, or postdoc.
- Select your Stanford work location from the options listed, ensuring you provide accurate information.
- Choose one of the three sections regarding the Hepatitis B vaccine. If you wish to receive the vaccine, indicate this and provide a contact number for scheduling. If you decline the vaccine, read the provided statement, sign, and date it. If you have completed the vaccine series, enter the dates of each dose and titer results if applicable.
- Once all sections are completed, review your form for accuracy. Ensure all signatures and dates are present.
- Save your changes, download a copy for your records, and submit the completed form to Stanford University Occupational Health Center via the provided phone or fax number.
Complete your Hepatitis Declaration Form online to stay compliant and protect your health.
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Get answers to your most pressing questions about US Legal Forms API.
When did Hep B vaccine become mandatory?
Starting in 1991, all infants and young children were recommended to receive the hepatitis B vaccine. As a result, the incidence of hepatitis B virus infections in the United States has started to decline.
Is Hep B mandatory in California?
In addition to the above recommendations, California state law requires that children who attend childcare or K-12 school (excluding home school) have received specific numbers of several vaccines, including hepatitis B vaccine. Many colleges also require evidence of hepatitis B vaccination.
How do you prove you had Hep B vaccine?
To be certain that you are protected against hepatitis B, ask for a simple blood test to check your “antibody titers” that will confirm whether the vaccination was successful.
What is hepatitis B declaration form?
DECLINATION: I understand that due to my occupational exposure to blood or other poten tially infectious materials that I may be at risk of acquiring Hepatitis B Virus (HBV) infection. I have been given the opportunity to be vaccinated with Hepatitis B vaccine.
Is your employer required to make vaccination for hep b available to you?
In addition, employers must make hepatitis B vaccination available to these workers. Hepatitis B vaccination is recognized as an effective defense against HBV infection. The standard requires employers to offer the vaccination series to all workers who have occupational exposure.
Are Hep B vaccines mandatory?
Hepatitis B vaccination is recognized as an effective defense against HBV infection. The standard requires employers to offer the vaccination series to all workers who have occupational exposure.
Is Hep B vaccine required for high school in California?
Hepatitis B vaccination is required for students aged 4-6 admitted to California schools, it is not required after 7 years of age. Students entering seventh grade are required to have a Tdap booster (Tetanus, reduced diphtheria, and pertussis).
What vaccines are mandatory for school in California?
Students Admitted at TK/K-12 Need: Diphtheria, Tetanus, and Pertussis (DTaP, DTP, Tdap, or Td) — 5 doses. (4 doses OK if one was given on or after 4th birthday. ... Polio (OPV or IPV) — 4 doses. ... Hepatitis B — 3 doses. ... Measles, Mumps, and Rubella (MMR) — 2 doses. ... Varicella (Chickenpox) — 2 doses.
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