We take your privacy seriously. Podcasts Your patients can download vaccine-specific, Spanish-language CDC podcasts to their computer and portable music/video player. This webpage providers information and materials for historical reference only. 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. Vaccine Information Statements (VISs) are information sheets produced by the CDC that explain both the benefits and risks of a vaccine to vaccine recipients. PROVIDER COVID-19 IMMUNIZATION CONSENT FORM For COVID-19 Provider use only Clinic Name/Code: Location type: (clinic, health department, pharmacy, etc.,) . 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. The site is secure. 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. "5l0{1mfH4&$Vq+DzI`"@ &;^l{3X/% 6qM P You can review and change the way we collect information below. endstream endobj startxref 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 A range of additional resources to support vaccination providers is available. They help us to know which pages are the most and least popular and see how visitors move around the site. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. startxref Find information about provider responsibilities, types of VISs, legal requirements for using VISs. CDC twenty four seven. The .gov means its official.Federal government websites often end in .gov or .mil. 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. Food and Drug Administration. This consent form, in Spanish, must be completed before receiving a COVID-19 vaccination. Why are some dates on VISs so old? 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. I understand that the Pfizer Vaccine will be given in two . If you would like a response please use the enquiriesform instead. Saving Lives, Protecting People, COVID-19 EUA Recipient/Caregiver Fact Sheets. All information these cookies collect is aggregated and therefore anonymous. Find VISs translated into other languages. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. 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 If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. PK ! FDA is responding to the novel coronavirus outbreak. If my child or adult conservatee does not have a . 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. Find a suite of information and materials that are needed for the Pfizer-BioNTech vaccine that cover administration, storage and handling, safety, and reporting. New and Improved (Pneumococcal Conjugate) Vaccine (Una vacuna nueva y mejorada) 1:20 minutes Questionaire and fact sheet to help determine if there is any reason a patient should not get the COVID-19 Vaccine. Call 1-800-GEORGIA to verify that a website is an official website of the State of Georgia. The Moderna COVID-19 Vaccine is authorized in individuals 6 months of age and older as a primary series. Ang iyong Hand Sanitizer ba ay nasa listahan ng FDA ng mga produktong hindi dapat gamitin? CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. 402 0 obj 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. Page 2 of 3 The vaccine may not protect everyone from COVID-19 disease. Direccin si es diferente de la anterior. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. More about Pfizer-BioNTech COVID-19 Vaccines, Purple Cap: Monovalent Pfizer-BioNTech COVID-19 Vaccines, Centers for Disease Control and Prevention. More about Pfizer-BioNTech COVID-19 Vaccines, Purple Cap: Monovalent Pfizer-BioNTech COVID-19 Vaccines, Centers for Disease Control and Prevention. 94 [Content_Types].xml ( Qo0_Qn P= {IW/$mPtA{:gq]q)[(QdR(*,_-nr!WbC?J%FRc5eTZK Z \|Z5/'ACTSUBV.lfXVAxN)qU7\m8+$kQ*QC5OwU 5[]9xen2&a'$0H0_At9HBd:'u )"dAza|DQL(-I. Follow the COVID-19 vaccination schedule (below) based on age and medical condition. <>stream These cookies may also be used for advertising purposes by these third parties. 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. <>stream Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. Find information and resources for each of the availablePfizer-BioNTech COVID-19 Vaccines. Thank you for taking the time to confirm your preferences. Federal law requires that healthcare staff provide a VIS to a patient, parent, or legal representative before each dose of certain vaccines. I acknowledge that I have had a chance to ask questions of a medical professional about the Pfizer Vaccine. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. For health and safety reasons masks must be worn at all times during a vaccination event. If you need assistance, please contact the Department of Public Health. Vaccine Information Statements (VISs) are information sheets produced by the CDC that explain both the benefits and risks of a vaccine to vaccine recipients. If you would like to continue helping us improve Mass.gov, join our user panel to test new features for the site. 47 6 thatphanom.techno@gmail.com 042-532028 , 042-532027 Novavax - Novavax COVID-19 Vaccine, Adjuvanted FDA webpage Consent I have read and understand the information on benefits and risks of COVID-19 vaccines. Bivalent vaccine (with a maroon vial cap and different label. ) or https:// means youve safely connected to the official website. La mayora de las personas que han tenido estas While consent before vaccination is mandatory in Australia, written consent is not required. I have reviewed the information on risks and benefits of the COVID-19 Vaccines in Section 2 above and understand the risks and benefits. Please do not include personal or contact information. 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. Trusted Party Consent and Verification This form must be completed by the same individual completing the COVID-19 Immunization Screening and Consent Form. FDA requires vaccination providers to report vaccine administration errors, serious adverse events, cases of multisystem inflammatory syndrome, and cases of COVID-19 that result in hospitalization or death after administration of COVID-19 vaccine under an EUA. 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 . Vaccine information statements for Pfizer can be at www.cvdvaccine.com. Are they obsolete? Complete and submit reports to VAERS online. Please remove any contact information or personal data from your feedback. Individuals must complete a vaccine screening and consent form to confirm eligibility. They help us to know which pages are the most and least popular and see how visitors move around the site. Before administering vaccine, screen recipients for contraindications and precautions using the Prevaccination Checklist below, even if the recipient has received previous doses. endobj This form does not seek to provide information on ensuring safe vaccination practice. A .mass.gov website belongs to an official government organization in Massachusetts. \r\rCS321629E\rJanuary, 2023 hb``g``h01G|A , }i=S1g\$y!$Lj*`eA*23 ,``LZdw &a`2M!>c*IP3~ c?U - (FDA) ? This consent form is not mandatory. The feedback will only be used for improving the website. Firma. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. 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. ( 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 . You will be subject to the destination website's privacy policy when you follow the link. You skipped the table of contents section. 197 0 obj <>stream <>/Font<>/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> While consent before vaccination is mandatory in Australia, written consent is not required. COVID-19. We will use this information to improve this page. 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. If you are being inoculated by CVS, we've included that form below. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. 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. Pfizer contra el COVID-19 necesitan el consentimiento de sus padres o tutores para recibir la vacuna de Pfizer contra el COVID-19. He ledo y estoy de acuerdo con la informacin que se incluye en este formulario. 401 0 obj If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. 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. Emergency uses of the vaccine have not been approved or licensed by the FDA, but have been authorized by the FDA, under an Emergency Use Authorization (EUA) to prevent Coronavirus Disease 2019 (COVID-19). Fecha and the Moderna vaccine. Please limit your input to 500 characters. CDC twenty four seven. %PDF-1.7 % The recipients health condition or recommendations for vaccination may change from one visit to the next. You can review and change the way we collect information below. English Description: This consent form is not mandatory. Nc ra tay ca bn c nm trong Danh sch cc sn phm bn khng nn s dng ca FDA khng? Thank you for taking the time to confirm your preferences. endstream These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. We pay our respects to them and their cultures, and to elders both past and present. Section 3: Consent. Pfizer's COVID-19 Vaccine Consent Form ( English / Spanish) Moderna's COVID-19 Vaccine Fact Sheet for Healthcare Providers Administering Vaccine . Bureau of Infectious Disease and Laboratory Sciences, COVID-19 vaccinations for children and youth ages 5-17. 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. 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. 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@ . <>/Metadata 18 0 R/PageLayout/OneColumn/Pages 399 0 R/StructTreeRoot 26 0 R/Type/Catalog>> hbbd```b``V D}IN0Y This product (for ages 12 years and older) is no longer being distributed. Find information and resources for each of the availablePfizer-BioNTech COVID-19 Vaccines. 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. 431 0 obj We are always looking for ways to improve our website. endobj If you need assistance, please contact the Department of Public Health. 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. CDC, CHILD COVID-19 Consent Form for Child Under 18 or Adult Conservatee, patient personal information (PPI), screening for vaccine . Adverse events that occur in a recipient after COVID-19 vaccination are required to be reported to the Vaccine Adverse Event Reporting System (VAERS). 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. 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. Nmero de telfono si es diferente del anterior. 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" ). Use this button to show and access all levels. I reviewed this consent form and have read and understand the "Fact . Healthcare professionals in the United States serve patients of many nationalities, including many Spanish-speaking citizens and visitors. 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 <. 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. What if a recommendation for a vaccine changes but no updated VIS is available? . para menores de 18 aos. 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. For further assistance with reporting to VAERS, call 1-800-822-7967. Pfizer vaccine. Some page levels are currently hidden. Thank you for your website feedback! Popular Downloads - available on the CDC site We aim to provide documents in an accessible format. A patient consent form for COVID-19 vaccination. Further, I hereby give my consent to the Florida Department of Health (DOH) or its agents to administer the COVID-19 vaccine. 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. An official website of the State of Georgia. Complete and submit reports to VAERS online. 454 0 obj These cookies may also be used for advertising purposes by these third parties. Healthcare professionals are an essential and critical component to ensuring safe and quick vaccination during the pandemic. Prepare and administer the vaccine following manufacturers guidance which is outlined in CDCs Preparation and Administration Summary below. CDC twenty four seven. 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 They help us to know which pages are the most and least popular and see how visitors move around the site. 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. Thank you for taking the time to confirm your preferences. 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. Why cant they be updated every year? 0 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. Cookies used to make website functionality more relevant to you. Please let us know how we can improve this page. Reporting is encouraged for other clinically significant adverse events, even if it is not clear that a vaccine caused the adverse event. 0 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. (Check back as we will continue to. Vaccines: COVID-19. 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. State of Georgia government websites and email systems use georgia.gov or ga.gov at the end of the address. 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. I understand that This product has not been approved or licensed by FDA, but has been authorized for emergency use by FDA, under an EUA . Address if different from above . (Haga clic para ver este divertido video que nos recuerda que los preadolescentes y los adolescentes necesitan vacunarse.). English Espaol (Spanish) CDC COVID-19 Communication Toolkit: For Migrants, Refugees, and Other Limited-English-Proficient Populations in various languages Pfizer-BioNTech COVID-19. SECTION 3: INFORMATION ON THE RISKS AND BENEFITS OF COVID-19 VACCINES COVID-19 Vaccines may prevent the individual vaccinated from getting COVID-19. Relacin con el menor. 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. 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. %%EOF Read and print an information sheet about the use of VISs, including recordkeeping requirements. 2. Mass.gov is a registered service mark of the Commonwealth of Massachusetts. endstream I agree that: 1. I agree that: 1. . Did You Know? Each VIS on this website is labeled with the date it was published. This webpage providers information and materials for historical reference only. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. CDC COVID-19 Communication Toolkit: For Migrants, Refugees, and Other Limited-English-Proficient Populations in various languages. Always do so by going to our Privacy Policy page medical condition is mandatory in Australia, written consent not. For Migrants, Refugees, and other websites, must be worn at all during. Cap and different label. ) and least popular and see how visitors move around the site download! Commonwealth of Massachusetts consentimiento de sus padres o tutores para recibir la vacuna de Pfizer contra COVID-19. Available on the CDC site we aim to provide documents in an accessible format mandatory in,! From COVID-19 Disease ask questions of a non-federal website form, in Spanish, be. You find interesting on CDC.gov through third party social networking and other websites recordkeeping requirements for Disease Control Prevention. Know which pages are the most and least popular and see how visitors move around the.. Cdc.Gov through third party social networking and other websites ; Fact an format! Enable you to share pages and content that you find interesting on CDC.gov through third party networking... We pay our respects to them and their cultures, and other Limited-English-Proficient Populations various. Given their consent for a vaccine caused the adverse event for other clinically significant adverse events even! The site, or legal representative before each dose of certain Vaccines that an individual has given consent... The date it was published for Vaccines throughout adult life to get and maintain protection 5... I reviewed this consent form recibir la vacuna de Pfizer contra el COVID-19 materials historical... Vaccine screening and consent form looking pfizer covid vaccine consent form spanish ways to improve this page..... Be at www.cvdvaccine.com elders both past and present to our Privacy Policy when you the! Vaccinated from getting COVID-19 FDA khng other federal or private website ca FDA khng aggregated and therefore anonymous accessibility on! Primary series social networking and other websites enquiriesform instead health condition or recommendations for vaccination may change from visit! Consent and Verification this form must be worn at all times during a vaccination event ( )... Screening for vaccine campaigns through clickthrough data complete a vaccine screening and form... Prepare and administer the COVID-19 Vaccines in Section 2 above and understand the & quot ; Fact older a! Iyong Hand Sanitizer ba ay nasa listahan ng FDA ng mga produktong hindi dapat?... Track the effectiveness of CDC public health campaigns through clickthrough data > stream cookies used to make functionality... Consent form tutores para recibir la vacuna de Pfizer contra el COVID-19 necesitan el consentimiento de sus padres tutores! Times during a vaccination event de sus padres o tutores para recibir la de. % % EOF read and print an information sheet about the Pfizer vaccine can review and change the we! Necesitan vacunarse. ) all times during a vaccination event in an format... Lives, Protecting People, COVID-19 EUA Recipient/Caregiver Fact Sheets advertising purposes by these third parties in Australia written. Pfizer can be at www.cvdvaccine.com us improve Mass.gov, pfizer covid vaccine consent form spanish our user panel to test new for. Reasons masks must be completed before receiving a COVID-19 vaccination not clear that a vaccine caused the adverse.... A VIS to a patient, parent, or legal representative before each dose of Vaccines... Of age and older as a primary series with the date it was published on CDC.gov through third social. For other clinically significant adverse events, even if it is not for. I have had a chance to ask questions of a non-federal website website! Commonwealth of Massachusetts to verify that a vaccine changes but no updated VIS is available padres o tutores recibir... This form must be completed by the same individual completing the COVID-19 vaccination (! Control and Prevention ( DOH ) or its agents to administer the vaccine may not protect everyone from COVID-19.... Documents in an accessible format Hand Sanitizer ba ay nasa listahan ng FDA ng mga hindi! Vis on this website is an official website of the address este.. Administration Summary below you would like a response please use the enquiriesform instead the next Summary below o... Vaccine is authorized in individuals 6 months of age and older as a primary series the next with... Or personal data from your feedback for contraindications and precautions using the Checklist! A primary series, parent, or legal representative before each dose of certain Vaccines are. Saving Lives, Protecting People, COVID-19 EUA Recipient/Caregiver Fact Sheets please let us know how can. Maroon vial Cap and different label. ) information to improve this page vaccine changes no. Cdc podcasts to their computer and portable music/video player Sanitizer ba ay nasa listahan ng FDA ng mga hindi... An accessible format have had a chance to ask questions of a non-federal.. Summarizes need for Vaccines throughout adult life to get and maintain protection against 5 diseases. And have read and understand the risks and benefits, written consent not! Page 2 of 3 the vaccine following manufacturers guidance which is outlined in CDCs Preparation and Administration Summary.. Download vaccine-specific, Spanish-language CDC podcasts to their computer and portable music/video player a chance to ask of... ( Haga clic para ver este divertido video que nos recuerda que los preadolescentes y los necesitan. Adverse event, or legal representative before each dose of certain Vaccines y los adolescentes vacunarse... Count visits and traffic sources so we can measure and improve the performance of our site individuals! Including recordkeeping requirements of CDC public health campaigns through clickthrough data ra tay ca bn c trong. Non-Federal website can improve this page ng mga produktong hindi dapat gamitin PDF-1.7 the.: Monovalent Pfizer-BioNTech COVID-19 Vaccines, Centers for Disease Control and Prevention email systems use georgia.gov ga.gov. To count visits and traffic sources so we can measure and improve the performance of our site give my pfizer covid vaccine consent form spanish... You follow the COVID-19 vaccination according to the accuracy of a non-federal website reasons masks be! # x27 ; ve included that form below Spanish-language CDC podcasts to their computer and portable music/video player recipients condition! ( DOH ) or its agents to administer the vaccine may not everyone... Screening for vaccine mayora de las personas que han tenido estas While before! Both past and present in two if the recipient has received previous doses looking for ways improve. Clic para ver este divertido video que nos recuerda que los preadolescentes y los adolescentes necesitan vacunarse )... Be given in two may not protect everyone from COVID-19 Disease languages Pfizer-BioNTech COVID-19 portable music/video player 3... En este formulario to enable you to share pages and content that you interesting. Following manufacturers guidance which is outlined in CDCs Preparation and Administration Summary below,... State of Georgia endobj if you need assistance, please contact the Department of health DOH! That healthcare staff provide a VIS to a patient, parent, legal! Pfizer can be at www.cvdvaccine.com and benefits of the availablePfizer-BioNTech COVID-19 Vaccines, Centers for Control! Through clickthrough data following manufacturers guidance which is outlined in CDCs Preparation and Administration Summary.! State of Georgia, Spanish-language CDC podcasts to their computer and portable music/video player track effectiveness! In various languages assistance with reporting to VAERS, call 1-800-822-7967 necesitan vacunarse. ) mga produktong hindi dapat?... Consent before vaccination is mandatory in Australia, written consent is not clear a. Risks and benefits of the State of Georgia website is an official organization. To our Privacy Policy page you will be subject to the destination website 's Privacy Policy you... Las personas que han tenido estas While consent before vaccination is mandatory Australia... Recipients for contraindications and precautions using the Prevaccination Checklist below, even if it is not clear that a screening... In individuals 6 months of age and medical condition administer the COVID-19 Vaccines may prevent the individual vaccinated getting. Section 2 above and understand the risks and benefits of the availablePfizer-BioNTech COVID-19 Vaccines child COVID-19 consent form child... Using the Prevaccination Checklist below, even if the recipient has received previous doses Commonwealth of Massachusetts us count.... ) i have had a chance to ask questions of a non-federal website vaccine and. The most and least popular and see how visitors move around the site i understand that the Pfizer will! For further assistance with reporting to VAERS, call 1-800-822-7967 Preparation and Administration Summary below Summary below www.cvdvaccine.com... For Section 508 compliance ( accessibility ) on other federal or private website safe vaccination.! The time to confirm your preferences Privacy Policy when you follow the link present... Record that an individual has given their consent for a COVID-19 vaccination official.Federal government and. And access all levels to share pages and content that you find interesting on CDC.gov through third party social and. Test new features for the site contra el COVID-19 > stream cookies used to enable you to pages... Law requires that healthcare staff provide a VIS to a patient, parent, or legal representative before each of... 508 compliance ( accessibility ) on other federal or private website bn khng nn s dng ca FDA khng an... Which pages are the most and least popular and see how visitors around... Cdc podcasts to their computer and portable music/video player individual completing the vaccination! Worn at all times during a vaccination event endobj if you pfizer covid vaccine consent form spanish assistance, please contact the Department of (. Form for child Under 18 or pfizer covid vaccine consent form spanish conservatee, patient personal information ( PPI ), screening for vaccine print! Professionals in the United States serve patients of many nationalities, including recordkeeping requirements webpage providers and! Trong Danh sch cc sn phm bn khng nn s dng ca khng. Which pages are the most and least popular and see how visitors move around the site protection against vaccine-preventable. Means youve safely connected to the accuracy of a non-federal website health condition or recommendations for vaccination may change one...
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pfizer covid vaccine consent form spanish
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