Laserfiche WebLink
CONSENT FORM FOR RECEIVING THE HEPATITIS B VACCINE <br /> I have read or have had explained to me the information in this form(Information on the Hepatitis B Vaccine[Recombinant]. <br /> I have had a chance to ask questions that were answered to my satisfaction. <br /> I understand that it is not recommended for pregnant women to receive the Hepatitis B vaccine,and that a woman who discovers she has become <br /> pregnant after receiving one or more doses of the Hepatitis B vaccine should discontinue receiving the subsequent doses until after she is no longer <br /> pregnant and should also contact her obstetrician immediately. <br /> I understand that all three doses of the Hepatitis B Vaccine are necessary to afford protection from Hepatitis B and that it is my responsibility to <br /> receive all 3 doses on time as scheduled by the Employee Health Service. <br /> I understand that I should not take this vaccine if active infection is present or I have an allergy to any of the compounds contained within the <br /> vaccine. <br /> I understand that there is a possibility that I will experience an adverse side effect from the vaccine. <br /> I believe I understand the benefits and risks of the Hepatitis B Vaccine be given to me. <br /> Signature of Student/Instructor Signature of Witness Date <br /> REFUSAL FORM FOR THE HEPATITIS B VACCINE <br /> I understand that due to my occupational exposure to blood or other potentially infectious materials I may be at risk of acquiring hepatitis B virus <br /> (HBC)infection. I have been told where I can be vaccinated with hepatitis B vaccine. However,I decline hepatitis B vaccination at this time. I <br /> understand that by declining this vaccine,I continue to be at risk of acquiring hepatitis B,a serious disease. <br /> Signature of Student/ truc or Signature of Witness Date <br /> COMMENTS: <br />