Hepatitis B Forms

Introduction of New Forms

ROHP is replacing the former web-based Hepatitis B Vaccine Series Authorization for Services form with a downloadable form which can be completed and saved on your local hard drive or other storage device. In addition, we have included Hepatitis B Consent and Declination forms to be completed by those persons identified by the Principal Investigator and authorized by ROHP to have the Hepatitis B Vaccine Series.

How do I access these new forms?

These forms can be downloaded from the ROHP website by clicking on any of the Form titles and saved on your local hard drive or other storage device. When completed, the form(s) should be sent to ROHP either by email to rohp@bu.edu or faxed to the ROHP secure electronic fax number 617-977-8788.

Hepatitis B Vaccine Series Authorization for Services Form

This form is to be used by Principal Investigators. The Principal Investigator is responsible for identifying researchers who may become exposed to a blood borne pathogen when working with human blood or cerebral, synovial, pleural, peritoneal, pericardial and amniotic fluids or unfixed human tissue, human derived cell lines and human cell cultures. The Hepatitis B vaccine is made available to researchers at no cost. Those researchers choosing not to receive the vaccine must sign a declination form.

Note: Hepatitis B Virus has been demonstrated to survive in dried blood at room temperature on environmental surfaces for at least a week.

Hepatitis B Vaccine Series Consent/Declination Form 

This form should be completed by those researchers authorized to receive the Hepatitis B Vaccine Series and provide their consent to the vaccine.  The Hepatitis B vaccine is made available to researchers at no cost. Please follow the instructions above for sending the consent form to ROHP. Information on the consent may contain personal health information which is protected under HIPAA, therefore, please do not share or send the consent form to anyone other than ROHP.  This form should also be completed by those researchers authorized to receive the Hepatitis B Vaccine Series but decline the vaccine.  The Hepatitis B vaccine is made available to researchers at no cost. Please follow the instructions above for sending the consent form to ROHP.