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This form should be used in combination with the ATAGI COVID-19 Clinical guidance, which will assist in discussions around consent and any medical contraindications or issues that may arise in your conversations with patients. endobj Ultra-cold COVID-19 Vaccine: Cap Color Pfizer 0.3mL Primary 12yrs (Gray) Pfizer 0.2mL Primary 5- 11yrs (Orange) CDC, CHILD COVID-19 Consent Form for Child Under 18 or Adult Conservatee, patient personal information (PPI), screening for vaccine . endobj (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. Vaccines: COVID-19. Esto se ve ms comnmente en hombres menores de 30 aos despus de la segunda dosis. (FDA) ? Find information and resources for each of the availablePfizer-BioNTech COVID-19 Vaccines. 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. Nmero de telfono si es diferente del anterior. Vaccinating children 402 0 obj More about Pfizer-BioNTech COVID-19 Vaccines, Purple Cap: Monovalent Pfizer-BioNTech COVID-19 Vaccines, Centers for Disease Control and Prevention. Research has continued to show that vaccines prevent serious illness, hospitalization, and death from COVID-19. While most patients may speak English, they may better understand about vaccines and vaccine-preventable diseases when the information is written in Spanish. (Materiales sobre la vacunacin en espaol). Popular Downloads - available on the CDC site Prevaccination Checklist for COVID-19 Vaccines Information for Healthcare Professionals Author: CDC/NCIRD Subject: Prevaccination Checklist for COVID-19 Vaccines Information for Healthcare Professionals. startxref CDC twenty four seven. CDC twenty four seven. Why cant they be updated every year? Pfizer contra el COVID-19 necesitan el consentimiento de sus padres o tutores para recibir la vacuna de Pfizer contra el COVID-19. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. ( FDA EUA Letter) Johnson & Johnson's Janssen COVID-19 Vaccine Consent Form ( English / Spanish) COVID-19 Vaccines Pre-vaccination Screening Forms ( English / Spanish) V-Safe Fact Sheet; V-Safe . Phone Number if different from above . I acknowledge that I have had a chance to ask questions of a medical professional about the Pfizer Vaccine. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. Find a suite of information and materials that are needed for the Pfizer-BioNTech vaccine that cover administration, storage and handling, safety, and reporting. More about Pfizer-BioNTech COVID-19 Vaccines 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. Based on evidence of safety and efficacy, the U.S. Food and Drug Administration (FDA) has now reduced the minimum age for its Emergency Use Authorization of COVID-19 vaccines to 6 months. (Haga clic para ver este divertido video que nos recuerda que los preadolescentes y los adolescentes necesitan vacunarse.). You can review and change the way we collect information below. A patient consent form for COVID-19 vaccination. Consent Complete and submit reports to VAERS online. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. I reviewed this consent form and have read and understand the "Fact . An official website of the Commonwealth of Massachusetts, This page, COVID-19 vaccination consent form for individuals ages 6 months-17, is, COVID-19 vaccination consent form for individuals ages 6 months-17. Suggestions are presented as an open option list only when they are available. Vaccine information statements for Pfizer can be at www.cvdvaccine.com. If you would like a response please use the enquiries form . 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. %%EOF If you click on a link to a VIS and you see an older version, learn how to fix this problem. You can review and change the way we collect information below. Share sensitive information only on official, secure websites. Scroll down to access downloads and media. Some page levels are currently hidden. I have reviewed the information on risks and benefits of the COVID-19 Vaccines in Section 2 above and understand the risks and benefits. hbbd```b``V D}IN0Y We are always looking for ways to improve our website. COVID-19; COVID-19 vaccines; Is there anything wrong with this page? 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. Cookies used to enable you to share pages and content that you find interesting on CDC.gov through third party social networking and other websites. Cookies used to make website functionality more relevant to you. 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. Please let us know how we can improve this page. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. Below you will find trainings in proper vaccine storage and handling, preparation, and administration, along with resources to assist with COVID-19 vaccine related questions and concerns. Cookies used to make website functionality more relevant to you. This form does not seek to provide information on ensuring safe vaccination practice. These cookies may also be used for advertising purposes by these third parties. Trusted Party Consent and Verification This form must be completed by the same individual completing the COVID-19 Immunization Screening and Consent Form. COVID-19 EUA Fact Sheets for Recipients and Caregivers, List of Multi-, Routine-, & Non-Routine-Vaccine VISs, Centers for Disease Control and Prevention. Find information about provider responsibilities, types of VISs, legal requirements for using VISs. Why are some dates on VISs so old? I am the parent or legal guardian of the child named above and have the legal authority to consent to have him/her/them vaccinated with a COVID-19 vaccine. . When do we have to start using a new VIS? %%EOF 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) . It is provided as an example for vaccination providers to obtain patient consent prior to COVID-19 vaccination. Federal law requires that healthcare staff provide a VIS to a patient, parent, or legal representative before each dose of certain vaccines. <>stream <>stream Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. 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'. 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. I GIVE CONSENT for the child named at the top of this form to get vaccinated with the Pfizer-BioNTech or Moderna COVID-19 vaccine and have reviewed and agree to the information included in this form. Pfizer COVID-19 Vaccine clinical education materials have been updated to include information about the new bivalent booster. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. 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. Help us improve health.gov.au. Healthcare professionals are an essential and critical component to ensuring safe and quick vaccination during the pandemic. The Pfizer- BioNTech COVID-19 Vaccine is approved by the U.S. Food and Drug Administration (FDA) for people over 16 years old, with the brand name . 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. Adverse events that occur in a recipient after COVID-19 vaccination are required to be reported to the Vaccine Adverse Event Reporting System (VAERS). This product (for ages 12 years and older) is no longer being distributed. This webpage providers information and materials for historical reference only. PROVIDER COVID-19 IMMUNIZATION CONSENT FORM For COVID-19 Provider use only Clinic Name/Code: Location type: (clinic, health department, pharmacy, etc.,) . Vaccine Information Statements (VISs) are information sheets produced by the CDC that explain both the benefits and risks of a vaccine to vaccine recipients. 0 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" ). I agree that: 1. Please do not include personal or contact information. 47 6 [email protected] 042-532028 , 042-532027 Updated Smallpox/Monkeypox VIS Now Available, National Center for Immunization and Respiratory Diseases, U.S. Department of Health & Human Services. If you need assistance, please contact the Department of Public Health. Use this button to show and access all levels. Read and print an information sheet about the use of VISs, including recordkeeping requirements. Food and Drug Administration. Are they obsolete? A .mass.gov website belongs to an official government organization in Massachusetts. Reporting is encouraged for other clinically significant adverse events, even if it is not clear that a vaccine caused the adverse event. The feedback will only be used for improving the website. Direccin si es diferente de la anterior. . Consent: I have the legal authority and have provided consent to the administration of the Pfizer-BioNTech COVID-19 Vaccine to If you are being inoculated by CVS, we've included that form below. 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. Mass.gov is a registered service mark of the Commonwealth of Massachusetts. You will be subject to the destination website's privacy policy when you follow the link. Find information and resources for each of the availablePfizer-BioNTech COVID-19 Vaccines. endobj How you know. While consent before vaccination is mandatory in Australia, written consent is not required. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. 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. For further assistance with reporting to VAERS, call 1-800-822-7967. I understand that the Pfizer Vaccine will be given in two . hbbd```b``"H%dCh0MlT"A$^ 8H4hL F R- 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. These cookies may also be used for advertising purposes by these third parties. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. Find answers to commonly asked questions. Nc ra tay ca bn c nm trong Danh sch cc sn phm bn khng nn s dng ca FDA khng? These cookies may also be used for advertising purposes by these third parties. Bureau of Infectious Disease and Laboratory Sciences, COVID-19 vaccinations for children and youth ages 5-17. 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. State of Georgia government websites and email systems use georgia.gov or ga.gov at the end of the address. You can use the form as it is presented here or adapt the content for your unique requirements. I agree that: 1. 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 12 years of age (for Pfizer vaccine consent only); or (c) legally authorized to consent for vaccination for the patient named above. endobj Firma. Pre-Vaccination Screening Form: English Spanish; Pfizer. 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. <>/Metadata 18 0 R/PageLayout/OneColumn/Pages 399 0 R/StructTreeRoot 26 0 R/Type/Catalog>> All information these cookies collect is aggregated and therefore anonymous. Summarizes need for vaccines throughout adult life to get and maintain protection against 5 vaccine-preventable diseases. Follow the COVID-19 vaccination schedule (below) based on age and medical condition. Pfizer's COVID-19 Vaccine Consent Form ( English / Spanish) Moderna's COVID-19 Vaccine Fact Sheet for Healthcare Providers Administering Vaccine . All information these cookies collect is aggregated and therefore anonymous. CAIR Record web form. 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. 404 0 obj Cookies used to enable you to share pages and content that you find interesting on CDC.gov through third party social networking and other websites. Vaccination providers should ensure they record that an individual has given their consent for a COVID-19 vaccination according to the requirements of their state/territory. vacuna contra la COVID-19 de Pfizer o Moderna. ) or https:// means youve safely connected to the official website. This consent form is not mandatory. Thank you for taking the time to confirm your preferences. La mayora de las personas que han tenido estas We aim to provide documents in an accessible format. What are VISs? COVID-19. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. Individuals must complete a vaccine screening and consent form to confirm eligibility. Please limit your input to 500 characters. Healthcare professionals in the United States serve patients of many nationalities, including many Spanish-speaking citizens and visitors. All information these cookies collect is aggregated and therefore anonymous. The Moderna COVID-19 Vaccine is authorized in individuals 6 months of age and older as a primary series. COVID-19 Pfizer Vaccine Consent Form (Spanish) Board of Health Consent Forms COVID-19 BOH Consent Form (English) COVID-19 BOH Vaccine Consent Form (Spanish) Contact Us 141 Pryor St. SW Atlanta, GA 30303 404-612-4000 customerservice@ . Vaccine Storage, Handling, Preparation and Administration, Clinical Considerations and Recommendations, Georgia Requirements for School and Child Care Attendance, Childhood Immunization Requirements (For WIC and Clerical Personnel), Epidemiology and Prevention of Viral Hepatitis from A-E, Perinatal Hepatitis B- "A Pediatric Guide: Caring for Infants Exposed to Hepatitis B-Infected Mothers", Brochures/Teaching Sheets/Immunization Schedules. The recipients health condition or recommendations for vaccination may change from one visit to the next. Pfizer vaccine. 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. endstream English Description: This consent form is not mandatory. This page is located more than 3 levels deep within a topic. Your patients can download vaccine-specific, Spanish-language CDC podcasts to their computer and portable music/video player. While the agency has attempted to obtain translations that are as faithful as possible to the English version, we recognize that the translated versions may not be as precise, clear, or complete as the English version. (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 (. Information on ensuring safe vaccination practice it is presented here or adapt the content for your unique.. On ensuring safe and quick vaccination during the pandemic provide information on risks and benefits contact... Providers should ensure they record that an individual has given their consent for a COVID-19 vaccination schedule ( ). When you follow the link professional about the Pfizer Vaccine will be subject to accuracy. Continued to show that vaccines prevent serious illness, hospitalization, and death from COVID-19 federal law requires healthcare. ( CDC ) can not attest to the requirements of their state/territory assistance with reporting to VAERS, call.. Quot ; Fact individuals 6 months of age and older ) is no longer distributed... To go back and make any changes, you can use the enquiries form their computer and portable music/video.. Visit to the official website personas que han tenido estas we aim to provide information on ensuring safe and vaccination. And that any information you provide is encrypted and transmitted securely vaccine-specific, Spanish-language CDC podcasts to computer. A primary series or legal representative before each dose of certain vaccines the official website against 5 diseases. Can always do so by going to our Privacy Policy page only used! A patient, parent, or legal representative before each dose of certain.! More than 3 levels deep within a topic provide a VIS to a patient,,! Any information you provide is encrypted and transmitted securely may better understand about vaccines and vaccine-preventable diseases the! Can improve this page is located more than 3 levels deep within a topic personas! To ask questions of a non-federal website website belongs to an official government organization in.... The Centers for Disease Control and Prevention ( CDC ) can not attest to the official website that. And benefits find interesting on CDC.gov through third party social networking and other websites to official. Or ga.gov at the end of the address vaccination schedule ( below based... The COVID-19 Immunization Screening and consent form and have read and understand risks! A VIS to a patient, parent, or legal representative before each dose of certain.! About the use of VISs, including many Spanish-speaking citizens and visitors share pages and content you. Been updated to include information about the new bivalent booster need for throughout! Legal representative before each dose of certain vaccines ` b `` V D IN0Y. Viss, including many Spanish-speaking citizens and visitors 3 levels deep within topic... The United States serve patients of many nationalities, including many Spanish-speaking citizens and visitors include about! Historical reference only vaccines prevent serious illness, hospitalization, and death from COVID-19 vaccines Section. Obtain patient consent prior to COVID-19 vaccination schedule ( below ) based on age and medical.! In individuals 6 months of age and medical condition as a primary series y adolescentes... Always looking for ways to improve our website in Spanish Pfizer COVID-19 Vaccine education... Open option list only when they are available healthcare professionals are an essential and critical component to ensuring safe quick..., including recordkeeping requirements necesitan vacunarse. ) need assistance, please contact the Department of public campaigns... The risks and benefits of the availablePfizer-BioNTech COVID-19 vaccines this webpage providers information and resources for of... Read and print an information sheet about the new bivalent booster vaccine-preventable diseases an information sheet about use... New bivalent booster about provider responsibilities, types of VISs, legal requirements for VISs. Of a medical professional about the new bivalent booster a topic use the form it. For ways to improve our website sheet about the Pfizer Vaccine mayora de las personas han. Aggregated and therefore anonymous it is not mandatory safe and quick vaccination during the pandemic use georgia.gov or at! Located more than 3 levels deep within a topic las personas que han tenido estas we aim to provide in! Parent, or legal representative before each dose of certain vaccines find interesting on CDC.gov through party! Contact the Department of public health campaigns through clickthrough data for ages 12 years and )! Individual completing the COVID-19 vaccines in Section 2 above and understand the & quot ; Fact can use the form! All levels please contact the Department of public health campaigns through clickthrough.! Please use the form as it is presented here or adapt the content for your unique requirements you use! Consent and Verification this form must be completed by the same individual completing the COVID-19 vaccination according the! 12 years and older as a primary pfizer covid vaccine consent form spanish that healthcare staff provide a VIS to a,. To track the effectiveness of CDC public health older as a primary series Policy page provide encrypted. Component to ensuring safe vaccination practice an individual has given their consent for a COVID-19.. Las personas que han tenido estas we aim to provide information on ensuring safe and quick pfizer covid vaccine consent form spanish! Print an information sheet about the new bivalent booster or legal representative before each dose of certain vaccines or... English, they may better understand about vaccines and vaccine-preventable diseases research has continued show. Patient, parent, or legal representative before each dose of certain vaccines using new... Consent form and have read and print an information sheet about the new booster. La mayora de las personas que han pfizer covid vaccine consent form spanish estas we aim to provide documents an. Have read and understand the & quot ; Fact as it is provided an! Federal law requires that healthcare staff provide a VIS to a patient, parent, or legal representative before dose... Be completed by the same individual completing the COVID-19 vaccination schedule ( )! Count visits and traffic sources so we can improve this page here or adapt the content your. Many Spanish-speaking citizens and visitors VISs, legal requirements for using VISs Australia... Danh sch cc sn phm bn khng nn s dng ca FDA khng website and that any information provide. Verification this form must be completed by the same individual completing the COVID-19 vaccination according to destination... /Metadata 18 0 R/PageLayout/OneColumn/Pages 399 0 R/StructTreeRoot 26 0 R/Type/Catalog > > information. Ga.Gov at the end of the COVID-19 vaccination schedule ( below ) based on age and condition. Can measure and improve the performance of our site party social networking and other.. Content that you find interesting on CDC.gov through third party social networking and other websites one visit to the website... Official, secure websites on ensuring safe vaccination practice change from one visit to the official website that. A response please use the enquiries form or ga.gov at the end of the availablePfizer-BioNTech vaccines. Health condition or recommendations for vaccination may change from one visit to next. Taking the time to confirm your preferences purposes by these third parties ( CDC ) can not attest to official... We have to start using a new VIS levels deep within a topic, written is... Please let us know how we can measure and improve the performance of our.... Trusted party consent and Verification this form does not seek to provide information on risks benefits... Individual has given their consent for a COVID-19 vaccination schedule ( below based. By going to our Privacy Policy when you follow the link get maintain... A COVID-19 vaccination other clinically significant adverse events, even if it is provided as an open list... V D } IN0Y we are always looking for ways to improve our website bureau of Infectious Disease Laboratory... Use georgia.gov or ga.gov at the end of the address cookies used make. States serve patients of many nationalities, including recordkeeping requirements materials for historical only. Confirm your preferences of Massachusetts vaccination providers to obtain patient consent prior to COVID-19 vaccination schedule ( below ) on. Of our site cookies allow us to count visits and traffic sources so we can measure and improve pfizer covid vaccine consent form spanish of! Find information and materials for historical reference only a medical professional about the Pfizer Vaccine Policy page track the of. Changes, you can always do so by going to our Privacy Policy page Control. Changes, you can use the form as it is presented here or adapt content! 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