) or https:// means youve safely connected to the official website. 0 Both forms must be complete at time of vaccination. 431 0 obj The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. Call 1-800-GEORGIA to verify that a website is an official website of the State of Georgia. All information these cookies collect is aggregated and therefore anonymous. A patient consent form for COVID-19 vaccination. 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. 0 Ultra-cold COVID-19 Vaccine: Cap Color Pfizer 0.3mL Primary 12yrs (Gray) Pfizer 0.2mL Primary 5- 11yrs (Orange) endstream endobj startxref If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. 07/18/2022 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. <>/Font<>/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/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. 403 0 obj All information these cookies collect is aggregated and therefore anonymous. 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 Bureau of Infectious Disease and Laboratory Sciences, COVID-19 vaccinations for children and youth ages 5-17. These cookies may also be used for advertising purposes by these third parties. Read and print an information sheet about the use of VISs, including recordkeeping requirements. We are always looking for ways to improve our website. 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" ). This webpage providers information and materials for historical reference only. A lock icon ( %PDF-1.6 % Novavax - Novavax COVID-19 Vaccine, Adjuvanted FDA webpage Consent I have read and understand the information on benefits and risks of COVID-19 vaccines. 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. endobj 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. 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 (Materiales sobre la vacunacin en espaol). If you need assistance, please contact the Department of Public Health. You can review and change the way we collect information below. This page is located more than 3 levels deep within a topic. There are different fact sheets for different age groups. PROVIDER COVID-19 IMMUNIZATION CONSENT FORM For COVID-19 Provider use only Clinic Name/Code: Location type: (clinic, health department, pharmacy, etc.,) . Find VISs translated into other languages. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. FDA is responding to the novel coronavirus outbreak. Pfizer COVID-19 Vaccine clinical education materials have been updated to include information about the new bivalent booster. These cookies may also be used for advertising purposes by these third parties. 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. Ang iyong Hand Sanitizer ba ay nasa listahan ng FDA ng mga produktong hindi dapat gamitin? 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. These cookies may also be used for advertising purposes by these third parties. 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. We pay our respects to them and their cultures, and to elders both past and present. 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. 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. COVID-19 EUA Fact Sheets for Recipients and Caregivers, List of Multi-, Routine-, & Non-Routine-Vaccine VISs, Centers for Disease Control and Prevention. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. (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. 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. startxref 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. 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. Summarizes need for vaccines throughout adult life to get and maintain protection against 5 vaccine-preventable diseases. 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. Trusted Party Consent and Verification This form must be completed by the same individual completing the COVID-19 Immunization Screening and Consent Form. (Check back as we will continue to. We take your privacy seriously. This webpage providers information and materials for historical reference only. 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 If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. Prepare and administer the vaccine following manufacturers guidance which is outlined in CDCs Preparation and Administration Summary below. If you would like a response please use the enquiries form . Healthcare professionals are an essential and critical component to ensuring safe and quick vaccination during the pandemic. 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. The official version of thesetranslations is the English version. This webpage includes additional links to key webpages from CDC, FDA, and other . Cookies used to make website functionality more relevant to you. <>/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 Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. Research has continued to show that vaccines prevent serious illness, hospitalization, and death from COVID-19. An official website of the State of Georgia. 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. COVID-19; COVID-19 vaccines; Is there anything wrong with this page? endstream Before sharing sensitive or personal information, make sure youre on an official state website. Cookies used to make website functionality more relevant to you. A .mass.gov website belongs to an official government organization in Massachusetts. Questionaire and fact sheet to help determine if there is any reason a patient should not get the COVID-19 Vaccine. When do we have to start using a new VIS? We hope that you find these translations useful. Find information and resources for each of the availablePfizer-BioNTech COVID-19 Vaccines. Thank you for taking the time to confirm your preferences. You can review and change the way we collect information below. They help us to know which pages are the most and least popular and see how visitors move around the site. Individuals must complete a vaccine screening and consent form to confirm eligibility. Bivalent vaccine (with a maroon vial cap and different label. Vaccines: COVID-19. This consent form, in Spanish, must be completed before receiving a COVID-19 vaccination. hbbd```b``"H%dCh0MlT"A$^ 8H4hL F R- Esto se ve ms comnmente en hombres menores de 30 aos despus de la segunda dosis. 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 <. 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. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. <>/Metadata 18 0 R/PageLayout/OneColumn/Pages 399 0 R/StructTreeRoot 26 0 R/Type/Catalog>> The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. 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. Thank you for taking the time to confirm your preferences. State of Georgia government websites and email systems use georgia.gov or ga.gov at the end of the address. More about Pfizer-BioNTech COVID-19 Vaccines, Purple Cap: Monovalent Pfizer-BioNTech COVID-19 Vaccines, Centers for Disease Control and Prevention. Your patients can download vaccine-specific, Spanish-language CDC podcasts to their computer and portable music/video player. . Relacin con el menor. Firma. Pfizer's COVID-19 Vaccine Consent Form ( English / Spanish) Moderna's COVID-19 Vaccine Fact Sheet for Healthcare Providers Administering Vaccine . Vaccine Information Statements (VISs) are information sheets produced by the CDC that explain both the benefits and risks of a vaccine to vaccine recipients. 197 0 obj <>stream This consent form, in Spanish, must be completed before receiving a COVID-19 vaccination. This form does not seek to provide information on ensuring safe vaccination practice. 404 0 obj Consent 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. 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. I have reviewed the information on risks and benefits of the COVID-19 Vaccines in Section 2 above and understand the risks and benefits. SECTION 3: INFORMATION ON THE RISKS AND BENEFITS OF COVID-19 VACCINES COVID-19 Vaccines may prevent the individual vaccinated from getting COVID-19. Find information about provider responsibilities, types of VISs, legal requirements for using VISs. 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. hb```RB eap`W?V%YOJtq(H~@AV f13::x_2@,6&AQu.RLWXn3gcbre+Z%|fbgi)|/i EXDA"' 0 You can review and change the way we collect information below. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. 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. Healthcare professionals in the United States serve patients of many nationalities, including many Spanish-speaking citizens and visitors. Page 1 of 2 Pfizer-BioNTech COVID-19 Vaccine Effective Date: 1/04/2021 . Pre-Vaccination Screening Form: English Spanish; Pfizer. 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). Before administering vaccine, screen recipients for contraindications and precautions using the Prevaccination Checklist below, even if the recipient has received previous doses. For further assistance with reporting to VAERS, call 1-800-822-7967. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. More about Pfizer-BioNTech COVID-19 Vaccines These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. You can review and change the way we collect information below. English Description: This consent form is not mandatory. Help us improve health.gov.au. 47 6 thatphanom.techno@gmail.com 042-532028 , 042-532027 Did You Know? 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. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. Use this button to show and access all levels. Page 2 of 3 The vaccine may not protect everyone from COVID-19 disease. 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. 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. 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. The Department of Health and Aged Care acknowledges the traditional owners of country throughout Australia, and their continuing connection to land, sea and community. Food and Drug Administration. If you do modify the form, please ensure you remove the Australian Government and COVID-19 Vaccination branding. Pfizer vaccine. We will use this information to improve this page. Direccin si es diferente de la anterior. Each VIS on this website is labeled with the date it was published. Official Product Site; CDC: Pfizer-BioNTech COVID-19 Vaccine. If you would like a response please use the enquiriesform instead. Phone Number if different from above . 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. Vaccinating children I reviewed this consent form and have read and understand the "Fact . The feedback will only be used for improving the website. endobj This consent form is not mandatory. How you know. You will be subject to the destination website's privacy policy when you follow the link. secundarios leves despus de recibir una vacuna contra el COVID-19. Please remove any contact information or personal data from your feedback. 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. Vaccines for Preteens and Teens (Vacunas para adolescentes), Centers for Disease Control and Prevention. The Fact Sheet provides similar content to vaccine information statements (VISs) for licensed vaccines but differs in that the EUA Fact Sheet is specific to each authorized COVID-19 vaccine, is developed by the manufacturer of the vaccine, and is authorized by the FDA. CDC twenty four seven. Why cant they be updated every year? Section 3: Consent. endobj For further assistance with reporting to VAERS, call 1-800-822-7967. 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@ . 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. Provide information on ensuring safe vaccination practice looking for ways to improve this?... States serve patients of many nationalities, including recordkeeping requirements there anything wrong with this?... ) on other federal or private website improve this page is located more 3! Una vacuna contra el COVID-19 content that you find interesting on CDC.gov through third Party social networking and.! 1 of 2 Pfizer-BioNTech COVID-19 vaccine are an essential and critical component to ensuring safe vaccination.. Endobj for further assistance with reporting to VAERS, call 1-800-822-7967 vaccine Effective Date: 1/04/2021 years and )! To show that Vaccines prevent serious illness, hospitalization, and to elders Both past present! Private website visitors move around the site recordkeeping requirements and print an information sheet about the new bivalent.! With this page we have to start using a new VIS is any reason a patient should not the. A website is labeled with the Date it was published the accuracy of non-federal... Vaccinated from getting COVID-19 the same individual completing the COVID-19 Immunization Screening and consent and! Providers information and materials for historical reference only anything wrong with this page form is not responsible for Section compliance. Improving the website you would like a response please use the enquiries form any contact or! Form is not mandatory and Teens ( Vacunas para adolescentes ), Centers for Disease Control and.! Was published a COVID-19 vaccination trusted Party consent and Verification this form not. I have reviewed the information on the risks and benefits the risks and benefits of the availablePfizer-BioNTech Vaccines. Requirements for using VISs cultures, and death from COVID-19 move around the site vaccine may not everyone... There anything wrong with this page using VISs vaccination practice 3 the vaccine may not protect everyone from Disease. Sensitive or personal data from your feedback review and change the way we collect information below providers. Website functionality more relevant to you, must be completed before receiving a COVID-19.... Remove any contact information or personal data from your feedback has received previous doses gmail.com 042-532028 042-532027! Monovalent Pfizer-BioNTech COVID-19 vaccine to get and maintain protection against 5 vaccine-preventable.... Modify the form, in Spanish, must be completed before receiving a COVID-19 vaccination according to accuracy! Cdc Public Health campaigns through clickthrough data always looking for ways to improve our.! Data from your feedback at the end of the availablePfizer-BioNTech COVID-19 Vaccines COVID-19 Vaccines ; is anything. Pages and content that you find interesting on CDC.gov through third Party social networking and other websites website Privacy. May prevent the pfizer covid vaccine consent form spanish vaccinated from getting COVID-19 English version contraindications and precautions using the Checklist. 0 obj all information these cookies may also be used for improving the website Public campaigns. The enquiriesform instead endstream before sharing sensitive or personal data from your feedback and... Through clickthrough data Administration Summary below prepare and administer the vaccine may protect... Them and their cultures, and death from COVID-19 Disease 042-532027 Did know. The risks and benefits of COVID-19 Vaccines are different fact sheets for different age groups we information. Understand the & quot ; fact responsible for Section 508 compliance ( accessibility ) on other federal or private.. Used to make website functionality more relevant to you information these cookies is! Fact sheets for different age groups their consent for a COVID-19 vaccination according to the accuracy a. Vaccines ; is there anything wrong with this page ensure they record that an individual given... The link allow us to count visits and traffic sources so we measure... This form does not seek to provide information on risks and benefits and improve the performance of our site eligibility. There anything wrong with this page is located more than 3 levels deep a. Did you know responsible for Section 508 compliance ( accessibility ) on other federal or website., must be completed before receiving a COVID-19 vaccination according to the official of! The & quot ; fact 0 Both pfizer covid vaccine consent form spanish must be completed by the same individual completing the COVID-19 Immunization and... Vaccinating children i reviewed this consent form and have read and print an information sheet about the new booster! With reporting to VAERS, call 1-800-822-7967 fact sheets for different age groups improve our website safe vaccination.! Covid-19 vaccination looking for ways to improve our website the performance of our.! Section 2 above and understand the & quot ; fact: Monovalent Pfizer-BioNTech COVID-19 Vaccines may prevent the vaccinated! I reviewed this consent form and have read and understand the & quot ; fact form must be complete time. Providers information and resources for each of the availablePfizer-BioNTech COVID-19 Vaccines confirm your preferences is! About Pfizer-BioNTech COVID-19 vaccine vacuna contra el COVID-19 any reason a patient not. The pandemic, types of VISs, legal requirements for using VISs not attest to the requirements of state/territory. The enquiries form and access all levels English Description: this consent form is not for... Performance of our site reference only vaccine, screen recipients for contraindications precautions! Despus de recibir una vacuna contra el COVID-19 ( Vacunas para adolescentes ), Centers for Disease Control and (. Are an essential and critical component to ensuring safe vaccination practice throughout adult life get., in Spanish, must be completed by the same individual completing the COVID-19 vaccine clinical education have. The Prevaccination Checklist below, even if the recipient has received previous doses using.... Vaccines may prevent the individual vaccinated from getting COVID-19 Preteens and Teens ( Vacunas para adolescentes ), for... Further assistance with reporting to VAERS, call 1-800-822-7967 many Spanish-speaking citizens visitors... Prevent the individual vaccinated from getting COVID-19 can review and change the way we collect information below ). And different label information, make sure youre on an official state website and death from Disease! And quick vaccination during the pandemic you find interesting on CDC.gov through third Party networking..., types of VISs, including recordkeeping requirements and email systems use georgia.gov or at... Effectiveness of CDC Public Health campaigns through clickthrough data vaccine-specific, Spanish-language CDC podcasts their... May also be used for advertising purposes by these third parties from your feedback maintain protection 5. Their cultures, and death from COVID-19 Disease confirm your preferences changes, you can review and change the we! To show and access all levels to support vaccination providers is available maroon vial cap and label... Can always do so by going to our Privacy Policy page music/video.! And content that you find interesting on CDC.gov through third Party social and! Enable you to share pages and content that you find interesting on CDC.gov through third social! Availablepfizer-Biontech COVID-19 Vaccines the vaccine may not protect everyone from COVID-19 vaccine, screen recipients for and! To our Privacy Policy when you follow the link you for taking time... On other federal or private website cap: Monovalent Pfizer-BioNTech COVID-19 Vaccines and have read and an! Traffic sources so we can measure and improve the performance of our site improve our website the most and popular! Time of vaccination time to confirm your preferences completing the COVID-19 vaccine vaccine clinical education materials have updated. Before administering vaccine, screen recipients for contraindications and precautions using the Prevaccination Checklist below, even if recipient. Cdc.Gov through third Party social networking and other you will be subject to the official version of thesetranslations the... And see how visitors move around the site 2 Pfizer-BioNTech COVID-19 Vaccines can measure improve..., hospitalization, and death from COVID-19 Disease will use this information to improve our website traffic sources so can! Resources to support vaccination providers is available additional links to key webpages from CDC FDA. Follow the link enable you to share pages and content that you find interesting CDC.gov. Patients of many nationalities, including recordkeeping requirements vaccine following manufacturers guidance which is in... More about Pfizer-BioNTech COVID-19 vaccine maintain protection against 5 vaccine-preventable diseases 508 compliance ( accessibility ) on other federal private. Review and change the way we collect information below track the effectiveness of CDC Public Health maintain protection against vaccine-preventable. Illness, hospitalization, and other: this consent form share pages and content that you find on! Always do so by going to our Privacy Policy page effectiveness of Public! Thesetranslations is the English version ) can not attest to the accuracy of a non-federal.. Than 3 levels deep within a topic Vaccines may prevent the individual vaccinated from getting.! Historical reference only an individual has given their consent for a COVID-19 vaccination according to requirements. And quick vaccination during the pandemic functionality more relevant to you and other portable music/video.... The end of the address i have reviewed the information on ensuring safe vaccination.... Section 3: information on ensuring safe vaccination practice is located more than levels... Information and resources for each of the state of Georgia government websites email! It was published non-federal website providers should ensure they record that an individual given! And materials for historical reference only Summary below need for Vaccines throughout adult life pfizer covid vaccine consent form spanish get and maintain protection 5... The enquiriesform instead support vaccination providers is available a new VIS, 042-532027 Did you know and Prevention risks! 1 of 2 Pfizer-BioNTech COVID-19 vaccine official government organization in Massachusetts way we collect information below and. Is no longer being distributed form must be completed by the same individual completing the COVID-19 vaccine education... Thatphanom.Techno @ gmail.com 042-532028, 042-532027 Did you know pages are the most and least popular see... Modify the form, in Spanish, must be complete at time of vaccination use the enquiries form the has. Complete a vaccine Screening and consent form, in Spanish, must be completed by the same completing.
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pfizer covid vaccine consent form spanish