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Student Hepatitis B Vaccine Declination <br /> I understand that due to my occupational exposure to blood or other potentially infectious <br /> materials-1 may be at risk of acquiring or transmitting Hepatitis B virus (HBV)infectious. <br /> However, I decline Hepatitis,B vaccination at this time. I understand that by declining <br /> this vaccine, I continue to be at risk of acquiring Hepatitis B, a serious disease. If, in the <br /> future, I continue to have occupational exposure to blood or other potentially infectious <br /> materials and I want to be vaccinated with Hepatitis B vaccine, I may do so, <br /> Reference: Appendix A, 29 Code of Federal Regulations 1910.1030 Occupational <br /> Elxposurc to Bloodborne Pathogens. Occupational Safety and Health Act. <br /> have decided not to receive injections of <br /> (Pr it Name) <br /> bate <br /> lAPolicy and Legal CHMealth Fornis,Crini Bkgrd Chek,drug screen,fingerprint for StudentsU-1calth <br /> Forms 2011,2012\Hep B Vaccine Decline Forni.doc <br />