Hepatitis Vaccine Consent Form

Keywords / Description:

Columbus Public Health created this hepatitis vaccination consent form to keep on file as a medical record. The one page form includes spaces to fill out the patients personal and contact information, as well as record identified risk for hepatitis, track specific data on the given vaccine, and the patients consenting signature.

Click here for NACCHO's Collection of Adult Hepatitis B Virus (HBV) Vaccination Tools and Resources.

Toolkit:

Infectious Disease Prevention and Control Toolkit

Keyword Area:

Immunization, Infectious Diseases, Workforce Competency

Jurisdiction:

Institutional Author:

Columbus Public Health

Submitted:

12/27/2010

Modified:

07/29/2011

The NACCHO Toolbox is a repository of available resources to help local public health practitioners. Tools are produced by local, state, and federal agencies, as well as academic institutions and other stakeholders. The contents of this Toolbox are solely the responsibility of the authors and do not necessarily reflect any official recommendations of NACCHO. NACCHO makes no express or implied warranty with respect to the contents and disclaims liability for any damages arising from or connected to the use of the material in this Toolbox.