endstream endobj startxref It is provided as an example for vaccination providers to obtain patient consent prior to COVID-19 vaccination. startxref Relacin con el menor. While consent before vaccination is mandatory in Australia, written consent is not required. CDC twenty four seven. This consent form, in Spanish, must be completed before receiving a COVID-19 vaccination. The U.S. Food and Drug Administration (FDA) has authorized the emergency use of certain COVID-19 Vaccines to prevent COVID-19 in individuals 6 months through 17 years under an If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. This consent form, in Spanish, must be completed before receiving a COVID-19 vaccination. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. Download and print these pieces or give your patients the Spanish-specific URLs and promote on-time vaccination across the life span in Spanish as well as in English. Before administering vaccine, screen recipients for contraindications and precautions using the Prevaccination Checklist below, even if the recipient has received previous doses. Please limit your input to 500 characters. Effective Date: 09/02/2022 DH8010-DCHP-08/2021 Page 2 of 2 DOH COVID-19 Vaccination Consent Form I certify that I am: (a) the patient and at least 18 years of age; (b) the legal guardian of the patient and confirm that the patient is at least 5 years of age (for Pfizer vaccine consent only); or (c) legally authorized to consent for vaccination for the patient named above. This form does not seek to provide information on ensuring safe vaccination practice. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. Pfizer vaccine. If you click on a link to a VIS and you see an older version, learn how to fix this problem. Thank you for taking the time to confirm your preferences. Download a prevaccination checklist in multiple languages. I have reviewed the information on risks and benefits of the COVID-19 Vaccines in Section 2 above and understand the risks and benefits. This webpage providers information and materials for historical reference only. Federal law requires that healthcare staff provide a VIS to a patient, parent, or legal representative before each dose of certain vaccines. Prevaccination Checklist for COVID-19 Vaccines Information for Healthcare Professionals Author: CDC/NCIRD Subject: Prevaccination Checklist for COVID-19 Vaccines Information for Healthcare Professionals. Official Product Site; CDC: Pfizer-BioNTech COVID-19 Vaccine. Consent: I have the legal authority and have provided consent to the administration of the Pfizer-BioNTech COVID-19 Vaccine to The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. Pag-unawa sa Terminolohiya ng Potensyal na Pag-iwas at Paggamot para sa COVID-19, Mag-ingat sa mga Pekeng Pagsusuri, Bakuna at Paggamot para sa Coronavirus, Kaligtasan sa Pagkain at Pagkakaroon sa panahon ng Pandemya ng Coronavirus, Mga Tip sa Tamang Nutrisyon at Paggamit ng na-update na Nutrition Facts Label sa Panahon ng Pandemyang Coronavirus, Mga Tanong at Sagot na Makatutulong tungkol sa Coronavirus (COVID-19) at ang inyong mga Alagang Hayop, COVID-19 Impormasyon para sa mga Mamimili Pamimili ng Pagkain, Mga Pinakamabisang Pamamaraan para sa mga Tindahan ng mga Pagkain, Mga Restawran, at mga Serbisyo sa Pag-pick-Up/Paghahatid ng Pagkain sa Panahon ng COVID-19 Pandemya, Paggamit ng mga Respirator, Facemasks, at Mga Takip sa Mukha sa Sektor ng Pagkain at Agrikultura Sa panahon ng Coronavirus Disease (COVID-19) Pandemya, Mga Kadalasang Tanong sa pagbawi ng Awtorisasyong Paggamit ng Emergencia (EUA)para sa Hydroxychloroquine Sulfate at Chloroquine Phosphate, Bit Cc La Chn iu Tr Ca Bn cho COVID-19, Ti sao bn khng nn s dng Ivermectin iu tr hoc ngn nga COVID-19. How you know. Cookies used to make website functionality more relevant to you. While consent before vaccination is mandatory in Australia, written consent is not required. %%EOF What are VISs? These cookies perform functions like remembering presentation options or choices and, in some cases, delivery of web content that based on self-identified area of interests. La mayora de las personas que han tenido estas Prepare and administer the vaccine following manufacturers guidance which is outlined in CDCs Preparation and Administration Summary below. Read and print an information sheet about the use of VISs, including recordkeeping requirements. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. <>stream Healthcare professionals are an essential and critical component to ensuring safe and quick vaccination during the pandemic. Reporting is encouraged for other clinically significant adverse events, even if it is not clear that a vaccine caused the adverse event. Firma. If you are being inoculated by CVS, we've included that form below. Complete and submit reports to VAERS online. Healthcare professionals in the United States serve patients of many nationalities, including many Spanish-speaking citizens and visitors. If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance. COVID-19; COVID-19 vaccines; Is there anything wrong with this page? All information these cookies collect is aggregated and therefore anonymous. vacuna contra la COVID-19 de Pfizer o Moderna. The Moderna COVID-19 Vaccine is authorized in individuals 6 months of age and older as a primary series. endobj COVID-19. %PDF-1.7 % 0 endstream endobj 171 0 obj <>/Metadata 26 0 R/Names 189 0 R/Outlines 31 0 R/Pages 168 0 R/StructTreeRoot 48 0 R/Type/Catalog/ViewerPreferences<>>> endobj 172 0 obj <. Pfizer and BioNTech have the following COVID-19 vaccine formulations for: Children ages 6 months - 4 years old: Monovalent vaccine (with a maroon vial cap ) Only authorized for the first two doses of the three-dose primary series: two doses (0.2 mL), at least three to eight weeks apart. If you do modify the form, please ensure you remove the Australian Government and COVID-19 Vaccination branding. Thank you for taking the time to confirm your preferences. Ultra-cold COVID-19 Vaccine: Cap Color Pfizer 0.3mL Primary 12yrs (Gray) Pfizer 0.2mL Primary 5- 11yrs (Orange) When do we have to start using a new VIS? I acknowledge that I have had a chance to ask questions of a medical professional about the Pfizer Vaccine. Why cant they be updated every year? Find a suite of information and materials that are needed for the Pfizer-BioNTech vaccine that cover administration, storage and handling, safety, and reporting. COVID-19 vaccination consent form for individuals ages 6 months - 17 - French - 6/25/22 (English, PDF 128.02 KB) COVID-19 vaccination consent form for individuals ages 6 months - 17 - Haitian Creole - 6/25/22 (Haitian Creole, PDF 124.25 KB) English Espaol Portugus, Portugal Ting Vit Kriolu di Cabo Verde Polski <>stream They help us to know which pages are the most and least popular and see how visitors move around the site. To support COVID-19 vaccination efforts nationwide, many healthcare professionals are needed, and therefore, it is crucial that they receive the necessary training to meet the demands of their roles. If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance. (Intramuscular) Injections/Subcutaneous Injections, of Recommendations for Adult Immunization, of Recommendations for Childhood and Adolescent Immunization, and minimum ages and intervals between vaccine doses of routinely recommended vaccines, Facebook page for Georgia Department of Public Health, Twitter page for Georgia Department of Public Health, Linkedin page for Georgia Department of Public Health, Instagram page for Georgia Department of Public Health, YouTube page for Georgia Department of Public Health, Storage and Handling of COVID-19 Vaccines, Pfizer-BioNTech COVID-19 Vaccine Training, Johnson & Johnson's Janssen COVID-19 Vaccine Training, COVID-19 Vaccine Training: General Overview of Immunization Best Practices for Healthcare Providers Understanding the Basics, Interim Clinical Considerations for Use of mRNA COVID-19 Vaccines Currently Authorized in the United States, Interim Considerations: Preparing for the Potential Management of Anaphylaxis After COVID-19 Vaccination, COVID-19 Interim Guidance for Immunization Services During the COVID-19 Pandemic, Clinical Considerations for COVID-19 Vaccination, Pfizers COVID-19 Vaccine Fact Sheet for Healthcare Providers Administering Vaccine, Modernas COVID-19 Vaccine Fact Sheet for Healthcare Providers Administering Vaccine, Johnson & Johnson's Janssen COVID-19 Fact Sheet for Healthcare Providers Administering Vaccine, Johnson & Johnson's Janssen's COVID-19 website, Recommended Child and Adolescent Immunization Schedule, Vaccine Standing Order Templates for Healthcare Providers, Modernas COVID-19 Vaccine Consent Form (, Johnson & Johnson's Janssen COVID-19 Vaccine Consent Form (, COVID-19 Vaccines Pre-vaccination Screening Forms (. Las vacunas Moderna y Pfizer contra el COVID-19 tienen un riesgo muy raro de inflamacin del corazn (llamada miocarditis o pericarditis). CDC twenty four seven. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. Bivalent vaccine (with a maroon vial cap and different label. Thank you for your website feedback! 404 0 obj CAIR Record web form. Suggestions are presented as an open option list only when they are available. (Haga clic para ver este divertido video que nos recuerda que los preadolescentes y los adolescentes necesitan vacunarse.). 454 0 obj Reporting is encouraged for other clinically significant adverse events, even if it is not clear that a vaccine caused the adverse event. (COVID-19) , , , (COVID-19) , , , / , , , , : 2020 6 19 , Matuto ng higit pa Tungkol sa Bakuna sa COVID-19 Mula sa FDA, Alamin Ang Iyong Mga Pagpipilian sa Paggamot para sa COVID-19, Bakit Hindi Ka Dapat Gumamit ng Ivermectin upang Gamutin o Maiwasan ang COVID-19. If you would like a response please use the enquiries form . Individuals must complete a vaccine screening and consent form to confirm eligibility. Find VISs translated into other languages. Pfizer-BioNTech COVID-19 Vaccine for Use in Individuals 5 through 11 Years of Age -- Fact Sheet for Recipients and Caregivers - (Chinese, Simplified (Mandarin dialect)) PDF. %%EOF Podcasts Your patients can download vaccine-specific, Spanish-language CDC podcasts to their computer and portable music/video player. CDC twenty four seven. You will be subject to the destination website's privacy policy when you follow the link. hb```RB eap`W?V%YOJtq(H~@AV f13::x_2@,6&AQu.RLWXn3gcbre+Z%|fbgi)|/i EXDA"' 0 The site is secure. A .mass.gov website belongs to an official government organization in Massachusetts. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. 402 0 obj For health and safety reasons masks must be worn at all times during a vaccination event. COVID-19 EUA Fact Sheets for Recipients and Caregivers, List of Multi-, Routine-, & Non-Routine-Vaccine VISs, Centers for Disease Control and Prevention. (Una vacuna nueva y mejorada) 1:20 minutes, Recommended Immunizations for Children from Birth through 6 Years, Common Questions about Infant Vaccination, Tips for a Less Stressful Shot Visit [2 pages], How to Hold Your Child during Vaccinations, Meningococcal Vaccine for Preteens and Teens, Vaccines for Preteens and Teens: What Parents Should Know, Q&A for Parents of Preteens HPV Vaccine, Questions and Answers for Parents about Preteen Vaccines, Information for Parents about Preteen Vaccines, New and Improved (Pneumococcal Conjugate) Vaccine, National Center for Immunization and Respiratory Diseases, Myocarditis and Pericarditis Considerations, How to talk to your patients about COVID-19 vaccination, COVID-19 Vaccination Program Operational Guidance, U.S. Department of Health & Human Services. Summarizes need for vaccines throughout adult life to get and maintain protection against 5 vaccine-preventable diseases. We take your privacy seriously. If you would like a response please use the enquiriesform instead. They help us to know which pages are the most and least popular and see how visitors move around the site. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. A lock icon ( We aim to provide documents in an accessible format. You skipped the table of contents section. 401 0 obj for the COVID-19 Pfizer Vaccine; (2) this COVID-19 Vaccine Consent Form for the Pfizer Vaccine; and (3) any additional information provided to me concerning COVID-19 vaccination. CDC twenty four seven. I agree that: 1. <>/Filter/FlateDecode/ID[<53903A2D9DB0B2110A004045A919FC7F>]/Index[401 54]/Info 400 0 R/Length 135/Prev 268176/Root 402 0 R/Size 455/Type/XRef/W[1 3 1]>>stream These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. Did You Know? Kin Thc C Bn V Th Nghim Coronavirus, Hiu Thut Ng V Cc Bin Php Ngn Nga v iu Tr Tim Nng i vi COVID-19, Coi chng cc Xt Nghim, Vc-Xin v Phng Php iu Tr Coronavirus la o, An Ton Thc Phm v S Sn C Trong i Dch Coronavirus, Cc Mo v Dinh Dng Tt v S Dng Nhn Thng Tin Dinh Dng Cp Nht Trong i Dch Coronavirus, Cc Cu Hi p Hu ch v Coronavirus (COVID-19) v Th Nui Ca Bn, COVID-19 Thng Tin cho Ngi Tiu Dng i Mua Thc Phm, Tm Tt cc Thc Hnh Tt Nht cho cc Ca Hng Thc Phm Bn L,Nh Hng, Nhn/Giao Thc Phm Trong Khi C i Dch COVID-19, S Dng Mt N Phng Hi c, Khu Trang, v Vi Che Mt trong Ngnh Thc Phm v Nng Nghip Trong Thi Gian c i Dch Bnh Coronavirus (COVID-19), Cc Cu Hi Th ng Gp v Vic Thu Hi y Quyn S Dng Khn Cp i vi vi Hydroxychloroquine Sulfate v Chloroquine Phosphate, Por que voc no deve usar a Ivermectina para Tratar ou Prevenir a COVID-19, Nthuav Qhia txog Cov Kev Coj Zoo Tshaj Plaws rau Cov Khw Muag Khoom Noj Khoom Haus, Cov Khw Ua Noj Ua Haus, thiab Cov Kev Neeg Tuaj Nqa/Kev Xa rau thaum lub caij muaj tus Kab Mob Kis Thoob Ntiaj Teb COVID-19, Soo Koobida Dhaqanada Fiican ee Loogu Talagalay Bakhaarada Tafaariiqda Raashinka, Makhaayadaha, iyo Adeegyada Qaadidda/Gaarsiinta Cuntada inta Lagu Jiro Faafidda COVID-19. This fun 30-second video (in Spanish) reminds us that preteens and teens need shots. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. endstream Both forms must be complete at time of vaccination. Trusted Party Consent and Verification This form must be completed by the same individual completing the COVID-19 Immunization Screening and Consent Form. FDA is responding to the novel coronavirus outbreak. Questionaire and fact sheet to help determine if there is any reason a patient should not get the COVID-19 Vaccine. Pfizer-BioNTech COVID-19 Vaccine Consent Form Sample for Minors COVID-19 Vaccine Consent For Individuals Under 18 Years of Age Section 1: Information about the child to receive a COVID-19 Vaccine (please print): Child's Name (Last, First, Middle) Date of Birth (mm/dd/yyyy)Age Street AddressCityStateZip Phone Number endobj Occupational Health and Safety Surveillance, Pregnancy Risk Assessment Monitoring System (PRAMS), Office of Health Indicators for Planning (OHIP), of Religious Objection to Immunization Spanish, Rules and Regulations: FAQs about Changes, Department of Public Health Certificate of Immunization (3231), Audit Checks for Child Care Facilities and Schools, Requirements and Recommendations for University System of Georgia Students, Guide 3231INS, Standards for Issuing and Filing Certificates of Immunization, of Georgia Immunization Requirements for Child Care & School Attendance, 3258 (Immunization Guidelines for Child Care Facility Operators and School Personnel), there for your child during shots (English and Spanish), for Teens: Protect Their Future (Spanish), Vaccine For Preteen Teaching Sheet English/, To the Wise: Immunize For Good Adult Health, of Refrigerated/Frozen Pack Needs for Different Climates, Recommendations Applying to Spacing and Administration of Routinely Recommended Childhood Vaccines, for Child and Adolescent Immunization Practices, Administration: Administer I.M. This product (for ages 12 years and older) is no longer being distributed. Further, I hereby give my consent to the Florida Department of Health (DOH) or its agents to administer the COVID-19 vaccine. SECTION 3: INFORMATION ON THE RISKS AND BENEFITS OF COVID-19 VACCINES COVID-19 Vaccines may prevent the individual vaccinated from getting COVID-19. Are they obsolete? The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. 170 0 obj <> endobj <> We take your privacy seriously. An official website of the State of Georgia. Cookies used to make website functionality more relevant to you. If my child or adult conservatee does not have a . to be available under an EUA for certain populations, including Pfizer-BioNTech COVID-19 vaccine for those individuals 6 months to 11 years old, and Moderna COVID-19 vaccine for individuals 6 months to 17 years old and for the administration of a third dose in the populations set forth in the consent section below. hbbd```b``V D}IN0Y Before sharing sensitive information, make sure you're on a federal government site. Saving Lives, Protecting People, 6 Months through 4 Years of Age Label Infographic, National Center for Immunization and Respiratory Diseases, Use of COVID-19 Vaccines in the U.S.: Appendices, FAQs for the Interim Clinical Considerations, Myocarditis and Pericarditis Considerations, Jurisdictions: Vaccinating Older Adults and People with Disabilities, Vaccination Sites: Vaccinating Older Adults and People with Disabilities, Vaccinating Patients upon Discharge from Hospitals, Emergency Departments & Urgent Care Facilities, Vaccines for Children Program vs. CDC COVID-19 Vaccination Program, FAQs for Private & Public Healthcare Providers, Talking with Patients about COVID-19 Vaccination, Talking to Patients with Intellectual and Developmental Disabilities, How to Tailor COVID-19 Information to Your Audience, How to Address COVID-19 Vaccine Misinformation, Ways to Help Increase COVID-19 Vaccinations, COVID-19 Vaccination Program Operational Guidance, What to Consider When Planning to Operate a COVID-19 Vaccine Clinic, Using the COVID-Vac Tool to Assess COVID-19 Vaccine Clinic Staffing & Operations Needs, Considerations for Planning School-Located Vaccination Clinics, How Schools and ECE Programs Can Support Vaccination, Customizable Content for Vaccination Clinics, Best Practices for Schools and ECE Programs, Connecting with Federal Pharmacy Partners, Resources to Promote the COVID-19 Vaccine for Children & Teens, COVID-19 Vaccine Access in Long-term Care Settings, Information for Long-term Care Administrators & Managers, Vaccinating Dialysis Patients and Healthcare Personnel, What Public Health Jurisdictions and Dialysis Partners Need to Know, Supporting Jurisdictions in Enrolling Healthcare Providers, Vaccine Administration Management System (VAMS), Resources for Jurisdictions, Clinics, and Organizations, 12 COVID-19 Vaccination Strategies for Your Community, How to Engage the Arts to Build COVID-19 Vaccine Confidence, Strategies for Reaching People with Limited Access to COVID-19 Vaccines, U.S. Department of Health & Human Services. It is provided as an example for vaccination providers to obtain patient consent prior to COVID-19 vaccination. Fecha All information these cookies collect is aggregated and therefore anonymous. Please let us know how we can improve this page. hb``g``h01G|A , }i=S1g\$y!$Lj*`eA*23 ,``LZdw &a`2M!>c*IP3~ c?U - Pfizer-BioNTech COVID-19 Vaccine is a monovalent COVID-19 vaccine that is authorized for emergency use to prevent COVID-19 as: The first two doses of the three-dose primary series for. Call 1-800-GEORGIA to verify that a website is an official website of the State of Georgia. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. This webpage providers information and materials for historical reference only. Please do not include personal or contact information. endobj CDC, CHILD COVID-19 Consent Form for Child Under 18 or Adult Conservatee, patient personal information (PPI), screening for vaccine . Administration of Pfizer-BioNTech COVID-19 Vaccines Administration Overview Before administering vaccine, screen recipients for contraindications and precautions using the Prevaccination Checklist below, even if the recipient has received previous doses. 2. Coronavirus Disease 2019 (COVID-19), Recalls, Market Withdrawals and Safety Alerts, COVID-19-Related Guidance Documents for Industry, FDA Staff, and Other Stakeholders, CDC COVID-19 Communication Toolkit: For Migrants, Refugees, and Other Limited-English-Proficient Populations, Pfizer-BioNTech COVID-19 Vaccine Fact Sheets for Recipients andCaregiversin multiple languages, Moderna COVID-19 Vaccine Fact Sheets for for Recipients andCaregiversin multiple languages, Janssen COVID-19 Vaccine Fact Sheets for Recipients andCaregiversin multiple languages, , 2019, (FDA) -19 (COVID-19) , -19 (COVID-19) , -19 (COVID-19) . You can review and change the way we collect information below. If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance. Immunize.org has organized links to all key printable (PDF) documents from CDC and FDA in the Checklist of Current Versions of U.S. COVID-19 Vaccination Guidance and Clinic Support Tools (abbreviated on this page as the "Checklist" ). hXmo6+""4ulb0VTlKQatz>@I(b 0[T,5L+[b143+p[`B' PLH$_0 G%4]8\:>'51h4{.ju-/>tuZL/rKDXx.Bi]YGqiEe1MwMX],76{%84~Mk9\GiN:Y,XKqzdE=q8S(O|z&03,F>,Q]XdR4t[|3&1C]b~/oCptT]ufeyFWtC$ekk!5~ssrrME7RXA^zSl|:8iFu?%PcB (ac69`ud=VI'. Updated Smallpox/Monkeypox VIS Now Available, National Center for Immunization and Respiratory Diseases, U.S. Department of Health & Human Services. Pfizer COVID-19 Vaccine clinical education materials have been updated to include information about the new bivalent booster. You will be subject to the destination website's privacy policy when you follow the link. Before sharing sensitive or personal information, make sure youre on an official state website. He ledo y estoy de acuerdo con la informacin que se incluye en este formulario. Use this button to show and access all levels. All information these cookies collect is aggregated and therefore anonymous. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. Each VIS on this website is labeled with the date it was published. and the Moderna vaccine. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. Saving Lives, Protecting People, National Center for Immunization and Respiratory Diseases, Use of COVID-19 Vaccines in the U.S.: Appendices, FAQs for the Interim Clinical Considerations, Myocarditis and Pericarditis Considerations, Jurisdictions: Vaccinating Older Adults and People with Disabilities, Vaccination Sites: Vaccinating Older Adults and People with Disabilities, Vaccinating Patients upon Discharge from Hospitals, Emergency Departments & Urgent Care Facilities, Vaccines for Children Program vs. CDC COVID-19 Vaccination Program, FAQs for Private & Public Healthcare Providers, Talking with Patients about COVID-19 Vaccination, Talking to Patients with Intellectual and Developmental Disabilities, How to Tailor COVID-19 Information to Your Audience, How to Address COVID-19 Vaccine Misinformation, Ways to Help Increase COVID-19 Vaccinations, COVID-19 Vaccination Program Operational Guidance, What to Consider When Planning to Operate a COVID-19 Vaccine Clinic, Using the COVID-Vac Tool to Assess COVID-19 Vaccine Clinic Staffing & Operations Needs, Considerations for Planning School-Located Vaccination Clinics, How Schools and ECE Programs Can Support Vaccination, Customizable Content for Vaccination Clinics, Best Practices for Schools and ECE Programs, Connecting with Federal Pharmacy Partners, Resources to Promote the COVID-19 Vaccine for Children & Teens, COVID-19 Vaccine Access in Long-term Care Settings, Information for Long-term Care Administrators & Managers, Vaccinating Dialysis Patients and Healthcare Personnel, What Public Health Jurisdictions and Dialysis Partners Need to Know, Supporting Jurisdictions in Enrolling Healthcare Providers, Vaccine Administration Management System (VAMS), Resources for Jurisdictions, Clinics, and Organizations, 12 COVID-19 Vaccination Strategies for Your Community, How to Engage the Arts to Build COVID-19 Vaccine Confidence, Strategies for Reaching People with Limited Access to COVID-19 Vaccines, U.S. Department of Health & Human Services. . ) < > stream Healthcare Professionals in the United States serve patients of many,! Non-Federal website our privacy policy when you follow the link official website of the COVID-19 vaccine consent! 508 compliance ( accessibility ) on other federal or private website legal representative before each dose of Vaccines! Have pfizer covid vaccine consent form spanish the information on risks and benefits of the State of Georgia inflamacin. Is provided as an open option list only when they pfizer covid vaccine consent form spanish available recuerda... A vaccine caused the adverse event relevant to you VIS and you see an older version learn... Product site ; CDC: Pfizer-BioNTech COVID-19 vaccine que se incluye en este.... For vaccination providers to obtain patient consent prior to COVID-19 vaccination visitors move around the site benefits of State! Please use the enquiries form subject to the accuracy of a non-federal website organization... Policy when you follow the link cap and different label include information about the new bivalent booster and... It is provided as an example for vaccination providers to obtain patient consent prior to COVID-19.. Use this button to show and access all levels including many Spanish-speaking citizens and visitors que preadolescentes! Click on a link to a VIS and you see an older version, learn how fix... Date it was published Healthcare staff provide a VIS and you see an older,! Before sharing sensitive information, make sure youre on an official website of the State Georgia. Vaccine-Specific, Spanish-language CDC Podcasts to their computer and portable music/video player Checklist below even! Y Pfizer contra el COVID-19 tienen un riesgo muy raro de inflamacin del corazn ( llamada miocarditis pericarditis! Verify that a website is an official State website time to confirm preferences. Reason a patient should not get the COVID-19 Immunization screening and consent form and older as a series! Pfizer vaccine vaccine-preventable diseases contraindications and precautions using the Prevaccination Checklist for COVID-19 Vaccines information for Healthcare Professionals Author CDC/NCIRD! You remove the Australian government and COVID-19 vaccination have had a chance to ask questions a., or legal representative before each dose of certain Vaccines to go back and make any,. Collect information below Vaccines may prevent the individual vaccinated from getting COVID-19 Centers for Control! How visitors move around the site you will be subject to the website! To verify that a vaccine screening and consent form, in Spanish, must completed! Product site ; CDC: Pfizer-BioNTech COVID-19 vaccine clinical education materials have been updated to include information the... Tienen un riesgo muy raro de inflamacin del corazn ( llamada miocarditis o pericarditis ), learn to. Covid-19 tienen un riesgo muy raro de inflamacin del corazn ( llamada miocarditis o pericarditis.. Dose of certain Vaccines ( in Spanish, must be complete at time of vaccination x27 ; included! Not attest to the Florida Department of health & Human Services our privacy policy page of COVID-19 in... He ledo y estoy de acuerdo con la informacin que se incluye en formulario! While consent before vaccination pfizer covid vaccine consent form spanish mandatory in Australia, written consent is not responsible for Section compliance... 1-800-Georgia to verify that a website is labeled with the date it published! Covid-19 Vaccines COVID-19 Vaccines COVID-19 Vaccines COVID-19 Vaccines ; is there anything wrong with this page la. Updated to include information about the Pfizer vaccine times during a vaccination event informacin que se incluye este. Not responsible for Section 508 compliance ( accessibility ) on other federal or private website include information the! Ages 12 years and older as a primary series track the effectiveness of CDC public health through... A link to a VIS and you see an older version, learn how fix. # x27 ; ve included that form below recipients for contraindications and precautions using the Prevaccination Checklist for COVID-19 information... Este formulario presented as an example for vaccination providers to obtain patient consent prior COVID-19! Vaccine caused the adverse event DOH ) or its agents to administer the COVID-19 Immunization screening and consent form o... The destination website 's privacy policy when you follow the link your patients can vaccine-specific... Screening and consent form to ask questions of a non-federal website, U.S. of. Seek to provide documents in an accessible format fecha all information these cookies us... Individuals must complete a vaccine screening and consent form, in Spanish, be! Que nos recuerda que los preadolescentes y los adolescentes necesitan vacunarse. ) prevent the individual from! On risks and benefits of the COVID-19 Immunization screening and consent form, in,! Riesgo muy raro de inflamacin del corazn ( llamada miocarditis o pericarditis ) get... Be complete at time of vaccination the time to confirm eligibility to make website functionality more relevant you... O pericarditis ) } IN0Y before sharing sensitive information, make sure on. You can review and change the way we collect information below our site let know. Information about the use of VISs, including many Spanish-speaking citizens and visitors Professionals in the States... If there is any reason a patient, parent, or legal representative before each of... Recuerda que los preadolescentes y los adolescentes necesitan vacunarse. ) is provided as open... Pfizer-Biontech COVID-19 vaccine response please use the enquiries form functionality more relevant to.. A patient, parent, or legal representative before each dose of certain Vaccines for Healthcare are! Individual completing the COVID-19 vaccine clinical education materials have been updated to include information about the Pfizer vaccine go and! To COVID-19 vaccination Pfizer COVID-19 vaccine the most and least popular and how! Reference only individual vaccinated from getting COVID-19 by CVS, we & # x27 ; ve included form! The date it was published video que nos recuerda que los preadolescentes y los adolescentes necesitan.... Us know how we can improve this page and make any changes, you always... ( Haga clic para ver este divertido video que nos recuerda que los y. A federal government site included that form below get and maintain protection against 5 vaccine-preventable diseases Vaccines... Pfizer vaccine attest to the accuracy of a non-federal website serve patients of many nationalities, including many citizens... To know which pages are the most and least popular and see how visitors move around the site information make... A medical professional about the Pfizer vaccine that Healthcare staff provide a VIS to a to. Completed by the same individual completing the COVID-19 Vaccines may prevent the vaccinated! Screen recipients for contraindications and precautions using the Prevaccination Checklist below, even if the recipient has previous. Recipients for contraindications and precautions using the Prevaccination Checklist for COVID-19 Vaccines information for Healthcare Professionals:... An open option list only when they are available Healthcare staff provide a VIS pfizer covid vaccine consent form spanish a to! Child or adult conservatee does not seek to provide information on the risks and.! And make any changes, you can always do so by going to our policy... Destination website 's privacy policy page: Pfizer-BioNTech COVID-19 vaccine is an official website of the State of Georgia how! Form below of VISs, including recordkeeping requirements move around the site the Prevaccination Checklist below, even if recipient... Pfizer COVID-19 vaccine the effectiveness of CDC public health campaigns through clickthrough data teens need shots individuals complete! Las vacunas Moderna y Pfizer contra el COVID-19 tienen un riesgo muy raro de inflamacin del corazn ( llamada o... Of our site thank you for taking the time to confirm your preferences V }. To COVID-19 vaccination branding button to show and access all levels this fun video. For Immunization and Respiratory diseases, U.S. Department of health & Human.! Professionals in the United States serve patients of many nationalities, including many Spanish-speaking citizens and visitors Author: subject! Read and print an information sheet about the use of VISs, including recordkeeping.... This website is an official State website para ver este divertido video que recuerda! Vaccines in Section 2 above and understand the risks and benefits of COVID-19 Vaccines may prevent the vaccinated... Of health & Human Services a website is labeled with the date it was published vaccination! He ledo y estoy de acuerdo con la informacin que se incluye en este formulario ages 12 and... Immunization screening and consent form to know which pages are the most and least popular and see how move... All levels the COVID-19 Vaccines information for Healthcare Professionals are an essential and critical component to ensuring safe practice. And print an information sheet about the new bivalent booster divertido video nos. This button to show and access all levels a maroon vial cap different... Non-Federal website is aggregated and therefore anonymous sure you 're on a link to a to! That preteens and teens need shots serve patients of many nationalities, including many Spanish-speaking citizens and visitors a! Youre on an official State website help us to count visits and traffic so! Section 508 compliance ( accessibility ) on other federal or private website to the accuracy of a medical professional the! Vial cap and different label each VIS on this website is labeled with the date it was published before a. To track the effectiveness of CDC public health campaigns through clickthrough data hereby give my consent to the website. Spanish ) reminds us that preteens and teens need shots wrong with this page when they available... Understand the risks and benefits sheet about the Pfizer vaccine this form must complete. Historical reference only Australian government and COVID-19 vaccination incluye en este formulario read and print an information sheet the! Will be subject to the destination website 's privacy policy when you follow the link reviewed the on!, we & # x27 ; ve included that form below on other federal private!
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