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University of Colorado Denver


I have been informed by Dr. that I am rubella non-immune. Rubella is a virus that can be prevented by vaccination. My blood tests indicate that I am rubella non-immune which means I am not protected from getting the rubella virus.

Rubella virus causes a disease that can result in fever, rash, and joint pain. However, if I am pregnant when I get the rubella virus the baby could be affected. Congenital rubella syndrome could result in mental retardation and blindness in the child.

I understand that I could be vaccinated against rubella to decrease the risk of getting rubella if I do get pregnant. If I get the vaccine I would have to delay conceiving for three months. I have decided that I do not want the rubella vaccine. I am willing to accept the risk of getting the rubella virus. I have been advised of the following guidelines for avoiding rubella exposure if I do become pregnant:

  1. Avoid all persons with rubella or a rubella-like illness during pregnancy.
  2. Avoid all persons with undiagnosed fevers and/or rashes.
  3. Receive the rubella vaccine after delivery to decrease the risk to future pregnancies.



Printed Name

University of Colorado Denver
Advanced Reproductive Medicine

Anschutz Medical Campus Office
Location: 1635 Aurora Court, Aurora, CO 80045
Mailing: PO Box 6510, Mail Stop F701, Aurora, CO 80045
Tel: 720.848.1690
Toll-free: 1.888.899.7441
Fax: 720.848.1678
Colorado Springs Office
4125 Briargate Parkway, Suite 350
Colorado Springs, CO 80920
Tel: 719.314.3333
Fax: 719.314.3344

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