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FormsStaffHealth/Safety → Hepatitis B Virus Vaccination Authorization

Hepatitis B Virus Vaccination Authorization

(Confidential)

About this Form

Form number: 230-32

Audience:  MCPS Staff

Last revised: April 2017

INSTRUCTIONS: Take this completed form to the health care center listed on the form to receive your MCPS authorized vaccinations at no charge to the employee. Questions regarding the MCPS Bloodborne Pathogens program may be directed to Systemwide Safety Programs, 240-314-1070.

Note: All medical records shall be kept confidential and may not be disclosed or reported without the employee's express written consent to any person within or without the workplace except as required by law, but may be reviewed and copied by the employee who is the subject of the file.

Adobe PDF Hepatitis B Virus Vaccination Authorization
(Confidential)
42 KEnglish

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