Hepatitis B: Condition of Enrollment

Contents:

• Hepatitis B Vaccination: Condition of Enrollment
  
• Printable flyer about the Hepatitis B requirement (pdf format)
  
• Hepatitis B Statement Form (pdf format)
• Hepatitis B Requirement Questions and Answers
• Are You at Risk for Hepatitis B?
• Increased Hepatitis B Risk in the Asian American/Pacific Islander Community
• Additional Information about Hepatitis B from the Hepatitis Foundation International

Hepatitis B Vaccination: Condition of Enrollment
The California State Legislature has mandated first-time enrollees at the University of California who are eighteen years of age or younger to provide proof of immunization against Hepatitis B as a condition of enrollment. If you will be under 19 on January 19, 2010 you must comply. The vaccine is a series of three doses: The second dose is given one month after the first, and the final dose is given five months after the second dose. Please follow the appropriate instructions below.

If you have completed the Hepatitis B immunization series:

• Read carefully the Hepatitis B statement form and complete the appropriate section.
  
  
• Completed forms must be returned by January 19, 2010 to assure compliance and protect enrollment status. Note that your health care provider's signature is required on sections 3 and 4.
  
  
• Mail form to:
  University Health Services/Hepatitis B
  2222 Bancroft Way, Suite 3220
  Berkeley, CA 94720-4300
  
  
• Or fax to:
  (510) 642-1801
  

If you are immune to Hepatitis B:

• If are immune to Hepatitis B, fill out section #1 or #3 of the Hepatitis B statement form and mail the form as above.

If you have started but not completed the Hepatitis B immunization series:

• If you have started the immunization series, complete section #2 of the Hepatitis B statement form and mail the form as above.
• If necessary, the series may be completed at University Health Services once you arrive on campus. Appointments may be scheduled at 643-7177. Bring your immunization record with you. Insurance coverage for members of the Student Health Insurance Plan (SHIP) begins mid-August (check with SHIP for the exact date). Non-SHIP members should check their health insurance plans for immunization coverage.

If you have a medical reason for not being immunized:

• If you have a medical reason for not being immunized complete section #4 of the Hepatitis B statement form and mail the form as above.

If Hepatitis B immunization is against your beliefs:

• If Hepatitis B immunization is against your beliefs, read and complete section #5 of the Hepatitis B statement form and mail as above. Note that if the student is 17 or younger and not an emancipated minor, this section must be signed by parent, guardian or emancipated minor.

For more information, see Hepatitis B Requirement Questions & Answers, or
call (510) 642-5560.

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