Arkansas Hepatitis B Vaccine Acceptance Declination Form

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US-0509BG
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The Occupational Safety and Health Act was passed to insure that employees have a safe place at which to work. The Occupational Safety and Health Administration, known as OSHA, was formed to enforce this Act. Completion of this form is a requirement of O

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FAQ

To attend a public or private college or university within the state of Arkansas, students must show proof of 2 MMR (measles, mumps, rubella) immunizations, immunity to measles, mumps, and rubella, a medical or non-medical exemption, or birth before January 1957.

The hepatitis A vaccine is recommended for school children. As of 2014, one dose of the vaccine is required for entry into kindergarten and first grade. Most adults are likely not vaccinated, unless they received vaccinations prior to traveling internationally.

I Decline the Hepatitis B Vaccination I have been given the opportunity to be vaccinated with hepatitis B vaccine, at no charge to myself. However, I decline hepatitis B vaccination at this time. I understand that by declining this vaccine, I continue to be at risk of acquiring hepatitis B, a serious disease.

Employers must ensure that workers who decline vaccination sign a declination form. The purpose of this is to encourage greater participation in the vaccination program by stating that a worker declin- ing the vaccination remains at risk of acquiring hepatitis B.

It is also possible that a person who does not respond to the vaccine may already be infected with hepatitis B. Therefore, testing for the presence of the hepatitis B virus (hepatitis B surface antigen or HBsAg) is recommended before diagnosing a person as a "vaccine non-responder."

If an employee initially declines the vaccination, and then decides to have it, the employer must pay for the initial vaccination series and post-vaccination testing, and second vaccination series and testing, if necessary.

The Centers for Disease Control and Prevention (CDC) recommends hepatitis A vaccination for all children in the United States when they are one year of age, all children and teens through age 18 who were not pre- viously vaccinated, certain children age 6 through 11 months who are traveling outside the U.S., all adults

For instance, sometimes the hepatitis B vaccination is delayed if a baby is premature, has a low birth weight, or is medically challenged. Still, parents always have the option to refuse a vaccination if they want to. But the risks associated with a hepatitis B infection far outweigh the risks of the vaccine.

HepA: Hepatitis A 17 states require the Hep A vaccine for kindergarten entry: Alaska, Arkansas, Connecticut, Georgia, Hawaii, Idaho, Indiana, Kansas, Kentucky, Nevada, Oklahoma, Oregon, South Carolina, Tennessee, Texas, Utah, and Virginia.

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Arkansas Hepatitis B Vaccine Acceptance Declination Form