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r <br />Ryan Edwin Gregg understand that due to my <br />occupational exposure to blood or other potentially infectious materials I may be at risk <br />of acquiring hepatitis B virus (HBV) infection. I have been given the opportunity to be <br />vaccinated with hepatitis B vaccine, at no charge to myself. However, I decline hepatitis <br />B vaccination at this time. I understand that by declining this vaccine, I continue to be <br />at risk of acquiring hepatitis B, a serious disease. If in the future I continue to have <br />occupational exposure to blood or other potentially infectious materials and I want to be <br />vaccinated with hepatitis B vaccine, I can receive the vaccination series at no charge to <br />me. <br />[56 FR 64004, Dec. 06, 1991, as amended at 57 FR 12717, April 13, 1992; 57 FR 29206, <br />July 1, 1992; 61 FR 5507, Feb. 13, 19961 <br />Ryan Gregg <br />Name (please print) <br />3/19/2019 <br />Siq/fature Jf U Date <br />