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Southern California . Tetanus, Diphtheria & Pertussis (Tdap) Declination Form. Print Name: I acknowledge that I am aware of the following .

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How to fill out the Tdap Declination Form online

Filling out the Tdap Declination Form is a straightforward process that helps individuals formally acknowledge their decision regarding the Tdap vaccination. This guide provides clear instructions to assist users in completing the form online.

Follow the steps to complete the Tdap Declination Form online.

  1. Click the ‘Get Form’ button to obtain the form and open it in the relevant online editor.
  2. In the 'Print Name' field, fill in your full name as you would like it to appear on the form.
  3. Read the acknowledgment section carefully to understand the information about pertussis and the risks associated with declining the vaccine.
  4. After reviewing, sign your name in the designated 'Signature' field to indicate your acknowledgment of the stated facts.
  5. Enter the current date in the 'Date' field; this should reflect the date you are submitting the form.
  6. Once all fields are filled out, review the information for accuracy before proceeding.
  7. You can then save changes, download, print, or share the completed form as needed, following the prompts in the online editor.

Begin completing your Tdap Declination Form online today for a seamless process.

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Should I get a Tdap shot? Yes. All pregnant women should get a Tdap shot in the third trimester, preferably between 27 weeks and 36 weeks of pregnancy. The Tdap shot is an effective and safe way to protect you and your baby from serious illness and complications of pertussis.

Vaccine Education Center Diphtheria, tetanus and pertussis are prevented by a childhood vaccine, called DTaP, and a vaccine for adolescents and adults, called Tdap. A version for adults is also available without the pertussis component, called Td.

Experts do not know what level of whooping cough antibodies is needed to protect anyone, including babies, from getting sick. That is why CDC recommends all women get Tdap during each pregnancy — even women with some antibodies due to a previous infection or vaccination.

Many pregnant women refuse the Tdap and influenza vaccines23 for a variety of reasons,24 including common misperceptions (“It will make me sick”), concerns for the safety of the fetus or neonate, and personal health beliefs (“I never get the flu shot”).

All pregnant women should get the Tdap vaccine during each pregnancy. The vaccine helps your body make antibodies to protect you from disease. These antibodies pass to your fetus and can protect your newborn until he or she can get the Tdap vaccine at 2 months old.

It can lead to breathing problems, paralysis, and heart failure. Even with treatment, about 1 out of 10 people with diphtheria die. PERTUSSIS (whooping cough) causes severe coughing spells that can cause breathing difficulty.

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