declination form


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declination form

A legal document that signals an individual's intent to refuse a recommended treatment, e.g. a requirement for vaccination of health care workers against influenza.
See also: form
References in periodicals archive ?
41 changes the definition of which authorized companies one can get a declination form, and requires that all affidavits must be in the possession of the excess line broker before coverage can be placed.
Although immunization is not yet mandatory at our hospital, we ask all employees who decline vaccine to fill out and sign a declination form.
Any employee who refuses must sign a declination form acknowledging "influenza is a serious respiratory disease that kills an average of 36,000 persons and hospitals more than 200,000 persons in the United States each year," as well as several similar not-so-fun facts.