It is important that Bakersfield Heart Hospital have a record of your influenza vaccination status. Please complete the form below and submit to Medical Staff.
Written declination is required by new California law (SB 739)
I acknowledge that I am aware of the following facts:
Influenza is a serious respiratory disease that kills, on average, 36,000 Americans every year.
Influenza virus may be shed for up to 48 hours before symptoms begin, allowing transmission to others.
Up to 30% of people with influenza have no symptoms, allowing transmission to others.
Flu virus changes often, making annual vaccination is necessary. Immunity following vaccination is strongest for 2 to 6 months. In California, influenza usually arrives around New Year through February or March.
I understand that flu vaccine cannot transmit influenza. It does not, however, prevent all disease.
I have declined to receive the influenza vaccine for the 2013-2014 seasons. I acknowledge that influenza vaccination is recommended by the CDC for all healthcare workers to prevent infection from and transmission of influenza and its complications, including death, to patients, my coworkers, my family, and my community.
Knowing these facts, if I choose to decline vaccination at this time.
I may change my mind and accept vaccination later, if vaccine is available.
I will wear a surgical or procedural mask, or other mask that covers my mouth and nose area, while performing duties in any patient care areas of the hospital during the influenza season.