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Tobacco City <br /> Vaccination Declination <br /> I understand that due to my occupational exposure to blood or other <br /> potentially infectious materials I may be at risk of acquiring hepatitis B <br /> virus (HBV) infection. I have been given the opportunity to be vaccinated <br /> with hepatitis B vaccine, at no charge to myself. However, I decline <br /> hepatitis B vaccination at this time. I understand that by declining this <br /> vaccine, I continue to be at risk of acquiring hepatitis B, a serious <br /> disease. If in the future I continue to have occupational exposure to <br /> blood or other potentially infectious materials and I want to be <br /> vaccinated with hepatitis B vaccine, I can receive the vaccination series <br /> at no charge to me. <br /> [56 FR 64004, Dec. 06, 1991, as amended at 57 FR 12717, April 13, <br /> 1992; 57 FR 29206, July 1, 1992; 61 FR 5507, Feb. 13, 1996] <br /> 012 <br />