Immunizations Declination

Immunizations Declination

Immunizations are required for hands-on experiences here at Aultman. Required immunizations, except for TB, can be waived by signing this form.

Hepatitis B
- Documented proof of a completed Hepatitis B series
- Positive Hepatitis B blood test titer.

- Documented proof of two immunizations
- Positive Rubella, Rubeola blood test titer.

- Documentation and date of last tetanus vaccine.
*Please note: As of 2007, the adult Tdap vaccine became available. If you had just a Tetanus, diphtheria vaccine (Td) prior to this becoming available, you will need to get a new tetanus vaccine which includes Tetanus, diphtheria and pertussis (Tdap).

- If you have received the Tdap vaccine: then one Td vaccine every 10 years is required.

- Documentation of receiving the Varicella vaccine
- Positive blood test titer.

Tuberculosis Testing **CAN NOT BE WAIVED**
- Documentation of a 2-step Mantoux test (TB) within the last 12 months
- 2-step Mantoux test (TB) with 1-step Mantoux test (TB) every year after