Form

Hepatitis B: requesting issue of immunoglobulin for infants

Form for antenatal departments to request issue of hepatitis B immunoglobulin for infants at risk of hepatitis B infection by perinatal transmission.

• From: UK Health Security Agency
• Published: 24 June 2014
• Last updated: 14 April 2023 — See all updates

Applies to England

Documents

Issue of immunoglobulin for infants at risk of hepatitis B infection

Ref: GOV-14275

MS Word Document, 353 KB

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Request an accessible format.

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Issue of immunoglobulin for infants at risk of hepatitis B infection (PDF)

Ref: GOV-14275

PDF, 134 KB, 2 pages

This file may not be suitable for users of assistive technology.

Request an accessible format.

If you use assistive technology (such as a screen reader) and need a version of this document in a more accessible format, please email publications@ukhsa.gov.uk. Please tell us what format you need. It will help us if you say what assistive technology you use.

Details

This form is for use by healthcare professionals to request immunoglobulin for infants at risk of hepatitis B infection. For multiple births, please complete a form for each infant.

Send completed request form to:

UK Health Security Agency

Hepatitis B Infant Study Coordinator
Immunisation Division
61 Colindale Avenue
London
NW9 5EQ

Published 24 June 2014
Last updated 14 April 2023 + show all updates

1. 14 April 2023

   Added updated request form.

2. 24 November 2021

   Added updated request form.

3. 4 September 2020

   Revised formatting to facilitate electronic completion and submission of forms. Minor updates to emergency HBIG dispatch guidance.

4. 5 May 2020

   Updated form to include latest ordering information.

5. 16 November 2017

   Revised request form to highlight the need to complete separate forms for each infant from a multiple birth.

6. 24 June 2014

   First published.