Get Generic Hepatitis A Declination Form

Filling out the Generic Hepatitis A Declination Form online is a straightforward process that helps ensure your health choices are documented. This guide provides clear instructions to assist you in completing the form accurately and efficiently.

Follow the steps to complete your form online

1. Click 'Get Form' button to obtain the form and open it in the editor.
2. Begin by filling in the date at the top of the form. This should reflect the current date when you are completing the declination.
3. In the space provided, enter your full name as the individual who is declining the vaccination.
4. Carefully read the section that outlines the risks associated with declining the vaccine, as well as the information regarding the opportunity for vaccination through your employer.
5. Next, you will confirm your decision by signing your name in the designated signature area. This affirms that you understand the implications of your decision.
6. After signing, enter the date on which you are signing the form.
7. A witness must sign the form. This individual can be a Department of Health employee or the owner/permit holder of the tattoo/body piercing facility. Their signature must be obtained in your presence.
8. Finally, record the date when the witness signs the form. Once all fields are completed, you can save your changes, download, print, or share the form as needed.

Complete your documents online for efficient processing.