Kentucky Hepatitis B Vaccine Acceptance Declination Form
Description
How to fill out Hepatitis B Vaccine Acceptance Declination Form?
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FAQ
If you make the choice not to vaccinate your child or children then you will need to have your family physician, pediatrician, nurse practitioner, pharmacist or local health department administrator sign either the religious exemption form or the medical exemption form.
A hepatitis B vaccine non-responder" refers to a person who does not develop protective surface antibodies after completing two full series of the hepatitis B vaccine and for whom an acute or chronic hepatitis B infection has been ruled out.
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.
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.
Religious exemptions shall be documented on a signed and notarized Commonwealth of Kentucky Parent or Guardian's Declination on Religious Grounds to Required Immunizations. There will be a space for the parent or guardian to initial each specific immunization they are choosing to decline.
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."
People who are non-responders after receiving the booster should be tested for hepatitis B virus infection. If negative, they are recommended to receive 2 more doses of hepatitis B vaccine 1 month apart. Count the 4th booster dose as the 1st of the 3 repeat doses.
