Code of Maryland Regulations
Title 10 - MARYLAND DEPARTMENT OF HEALTH
Part 1
Subtitle 06 - DISEASES
Chapter 10.06.05 - Meningococcal Vaccination Requirements for Students in Institutions of Higher Education
Section 10.06.05.06 - Waiver Form
Universal Citation: MD Code Reg 10.06.05.06
Current through Register Vol. 51, No. 19, September 20, 2024
A. A waiver form for an individual 18 years old or older shall:
(1) State that the individual:
(a) Is 18 years old or older;
(b) Has received and reviewed the information
provided by the institution of higher education on the risk of meningococcal
disease and the availability and effectiveness of meningococcal vaccine;
and
(c) Chooses to waive the
receipt of meningococcal vaccine; and
(2) Provide spaces for the:
(a) Printed name of the individual;
(b) Signature of the individual;
and
(c) Date.
B. A waiver form for an individual younger than 18 years old shall:
(1) State
that:
(a) The individual is younger than 18
years old;
(b) The parent or
guardian of the individual has received and reviewed the information provided
by the institution of higher education on the risk of meningococcal disease and
the availability and effectiveness of meningococcal vaccine; and
(c) The parent or guardian of the individual
chooses to waive the receipt of meningococcal vaccine for the individual;
and
(2) Provide spaces
for the:
(a) Printed name of the
individual;
(b) Printed name of the
parent or guardian;
(c) Signature
of the parent or guardian; and
(d)
Date.
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