Get Hepatitis Declaration Form State Of California

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.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. 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.
3. 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.
4. Select your Stanford work location from the options listed, ensuring you provide accurate information.
5. 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.
6. Once all sections are completed, review your form for accuracy. Ensure all signatures and dates are present.
7. 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.