New and Improved (Pneumococcal Conjugate) Vaccine (Una vacuna nueva y mejorada) 1:20 minutes We pay our respects to them and their cultures, and to elders both past and present. 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. These cookies may also be used for advertising purposes by these third parties. All information these cookies collect is aggregated and therefore anonymous. Top-requested sites to log in to services provided by the state. 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. \r\rCS321629E\rJanuary, 2023 endobj Section 3: Consent. I understand that the Pfizer Vaccine will be given in two . hb```RB eap`W?V%YOJtq(H~@AV f13::x_2@,6&AQu.RLWXn3gcbre+Z%|fbgi)|/i EXDA"' 0 CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. Consentimiento de vacuna contra la COVID-19. 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. %PDF-1.6 % Use this button to show and access all levels. The feedback will only be used for improving the website. The .gov means its official.Federal government websites often end in .gov or .mil. 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). Complete and submit reports to VAERS online. If you would like a response please use the enquiries form . 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. 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. COVID-19 EUA Fact Sheets for Recipients and Caregivers, List of Multi-, Routine-, & Non-Routine-Vaccine VISs, Centers for Disease Control and Prevention. hbbd```b``V D}IN0Y You can review and change the way we collect information below. <>stream COVID-19; COVID-19 vaccines; Is there anything wrong with this page? 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" ). 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. Find VISs translated into other languages. "5l0{1mfH4&$Vq+DzI`"@ &;^l{3X/% 6qM P (COVID-19) , , , (COVID-19) , , , / , , , , : 2020 6 19 , Matuto ng higit pa Tungkol sa Bakuna sa COVID-19 Mula sa FDA, Alamin Ang Iyong Mga Pagpipilian sa Paggamot para sa COVID-19, Bakit Hindi Ka Dapat Gumamit ng Ivermectin upang Gamutin o Maiwasan ang COVID-19. Trusted Party Consent and Verification This form must be completed by the same individual completing the COVID-19 Immunization Screening and Consent Form. What are VISs? 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. CDC twenty four seven. Popular Downloads - available on the CDC site 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. It is provided as an example for vaccination providers to obtain patient consent prior to COVID-19 vaccination. State of Georgia government websites and email systems use georgia.gov or ga.gov at the end of the address. I agree that: 1. Federal law requires that healthcare staff provide a VIS to a patient, parent, or legal representative before each dose of certain vaccines. These cookies may also be used for advertising purposes by these third parties. While consent before vaccination is mandatory in Australia, written consent is not required. 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. La mayora de las personas que han tenido estas This webpage providers information and materials for historical reference only. You will be subject to the destination website's privacy policy when you follow the link. Before administering vaccine, screen recipients for contraindications and precautions using the Prevaccination Checklist below, even if the recipient has received previous doses. Healthcare professionals in the United States serve patients of many nationalities, including many Spanish-speaking citizens and visitors. Ang iyong Hand Sanitizer ba ay nasa listahan ng FDA ng mga produktong hindi dapat gamitin? 401 0 obj 197 0 obj <>stream This product (for ages 12 years and older) is no longer being distributed. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. endobj CDC COVID-19 Communication Toolkit: For Migrants, Refugees, and Other Limited-English-Proficient Populations in various languages. 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. endstream Thank you for taking the time to confirm your preferences. Please remove any contact information or personal data from your feedback. You can review and change the way we collect information below. All information these cookies collect is aggregated and therefore anonymous. 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 <. endstream endobj startxref 47 6 thatphanom.techno@gmail.com 042-532028 , 042-532027 To receive email updates about this page, enter your email address: We take your privacy seriously. Vaccines: COVID-19. 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. Thank you for taking the time to confirm your preferences. %%EOF Individuals must complete a vaccine screening and consent form to confirm eligibility. Did You Know? %PDF-1.7 % Mercy COVID-19 Vaccine Consent Form - Spanish Author: Hixson, Frances M Subject: covid-19 consent form Spanish Created Date: If you would like to continue helping us improve Mass.gov, join our user panel to test new features for the site. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. 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) . A lock icon ( Why cant they be updated every year? Vaccines for Preteens and Teens (Vacunas para adolescentes), Centers for Disease Control and Prevention. Before sharing sensitive information, make sure you're on a federal government site. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. I reviewed this consent form and have read and understand the "Fact . These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. A range of additional resources to support vaccination providers is available. 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. 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. 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. endstream Federal law requires that healthcare staff provide a VIS to a patient, parent, or legal representative before each dose of certain 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. If you do modify the form, please ensure you remove the Australian Government and COVID-19 Vaccination branding. 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 . If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. Reporting is encouraged for other clinically significant adverse events, even if it is not clear that a vaccine caused the adverse event. Pre-Vaccination Screening Form: English Spanish; Pfizer. Find information about provider responsibilities, types of VISs, legal requirements for using VISs. 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. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. 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. English Description: This consent form is not mandatory. We are always looking for ways to improve our website. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. These cookies may also be used for advertising purposes by these third parties. 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 . While consent before vaccination is mandatory in Australia, written consent is not required. CAIR Record web form. 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. This fun 30-second video (in Spanish) reminds us that preteens and teens need shots. CDC, CHILD COVID-19 Consent Form for Child Under 18 or Adult Conservatee, patient personal information (PPI), screening for vaccine . Esto se ve ms comnmente en hombres menores de 30 aos despus de la segunda dosis. Pfizer vaccine. If you need assistance, please contact the Department of Public Health. A .mass.gov website belongs to an official government organization in Massachusetts. Nmero de telfono si es diferente del anterior. <>stream CDC twenty four seven. Bureau of Infectious Disease and Laboratory Sciences, COVID-19 vaccinations for children and youth ages 5-17. Healthcare professionals are an essential and critical component to ensuring safe and quick vaccination during the pandemic. You can review and change the way we collect information below. A patient consent form for COVID-19 vaccination. %%EOF Are they obsolete? 187 0 obj <>/Filter/FlateDecode/ID[<3C4CB76F7817EC43BD8A3A51D7CF58C8>]/Index[170 28]/Info 169 0 R/Length 90/Prev 97852/Root 171 0 R/Size 198/Type/XRef/W[1 3 1]>>stream 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. CDC twenty four seven. I agree that: 1. Official Product Site; CDC: Pfizer-BioNTech COVID-19 Vaccine. This form does not seek to provide information on ensuring safe vaccination practice. If you're having problems using a document with your accessibility tools, please contact us for help. Firma. 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 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. Cookies used to make website functionality more relevant to you. FDA is responding to the novel coronavirus outbreak. For further assistance with reporting to VAERS, call 1-800-822-7967. 2. Vaccine Information Statements (VISs) are information sheets produced by the CDC that explain both the benefits and risks of a vaccine to vaccine recipients. (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. This product (for ages 12 years and older) is no longer being distributed. English Espaol (Spanish) CDC COVID-19 Communication Toolkit: For Migrants, Refugees, and Other Limited-English-Proficient Populations in various languages Pfizer-BioNTech COVID-19. 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. 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. Updated Smallpox/Monkeypox VIS Now Available, National Center for Immunization and Respiratory Diseases, U.S. Department of Health & Human Services. Ultra-cold COVID-19 Vaccine: Cap Color Pfizer 0.3mL Primary 12yrs (Gray) Pfizer 0.2mL Primary 5- 11yrs (Orange) 454 0 obj PROVIDER COVID-19 IMMUNIZATION CONSENT FORM For COVID-19 Provider use only Clinic Name/Code: Location type: (clinic, health department, pharmacy, etc.,) . Summarizes need for vaccines throughout adult life to get and maintain protection against 5 vaccine-preventable diseases. 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. Thank you for taking the time to confirm your preferences. If you need assistance, please contact the Department of Public Health. Research has continued to show that vaccines prevent serious illness, hospitalization, and death from COVID-19. These cookies may also be used for advertising purposes by these third parties. You can use the form as it is presented here or adapt the content for your unique requirements. <>/Font<>/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> 170 0 obj <> endobj What if a recommendation for a vaccine changes but no updated VIS is available? Before sharing sensitive or personal information, make sure youre on an official state website. For health and safety reasons masks must be worn at all times during a vaccination event. 431 0 obj Find information and resources for each of the availablePfizer-BioNTech COVID-19 Vaccines. Page 2 of 3 The vaccine may not protect everyone from COVID-19 disease. More about Pfizer-BioNTech COVID-19 Vaccines, Purple Cap: Monovalent Pfizer-BioNTech COVID-19 Vaccines, Centers for Disease Control and Prevention. 0 Download a prevaccination checklist in multiple languages. For further assistance with reporting to VAERS, call 1-800-822-7967. Phone Number if different from above . Some page levels are currently hidden. Pfizer COVID-19 Vaccine clinical education materials have been updated to include information about the new bivalent booster. The official version of thesetranslations is the English version. An official website of the State of Georgia. Mass.gov is a registered service mark of the Commonwealth of Massachusetts. Please let us know how we can improve this page. Vaccine Information Statements (VISs) are information sheets produced by the CDC that explain both the benefits and risks of a vaccine to vaccine recipients. Please limit your input to 500 characters. 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. This consent form is not mandatory. They help us to know which pages are the most and least popular and see how visitors move around the site. 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'. An official website of the State of Georgia. We aim to provide documents in an accessible format. We take your privacy seriously. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. (Check back as we will continue to. endobj Find answers to commonly asked questions. Your patients can download vaccine-specific, Spanish-language CDC podcasts to their computer and portable music/video player. Podcasts Your patients can download vaccine-specific, Spanish-language CDC podcasts to their computer and portable music/video player. endobj Nc ra tay ca bn c nm trong Danh sch cc sn phm bn khng nn s dng ca FDA khng? 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. Consent 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. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. 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 They help us to know which pages are the most and least popular and see how visitors move around the site. Each VIS on this website is labeled with the date it was published. <>/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 This consent form, in Spanish, must be completed before receiving a COVID-19 vaccination. <> Cookies used to make website functionality more relevant to you. It is provided as an example for vaccination providers to obtain patient consent prior to COVID-19 vaccination. 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. Help us improve health.gov.au. . 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. Why cant they be updated every year date it was published example vaccination. To provide documents in an accessible format same individual completing the COVID-19 Immunization screening and consent form for Under. Control and Prevention you find interesting on CDC.gov through third Party social networking and other Limited-English-Proficient in! With this page and make any changes, you can always do so by going to our Privacy when! An official government organization in Massachusetts of Massachusetts ; rCS321629E & # 92 ;,... Las personas que han tenido estas this webpage providers information and materials for historical reference.... Of their state/territory and see how visitors move around the site vaccine clinical education materials have been updated include. Vaccine clinical education materials have been updated to include information about provider responsibilities, types of,! Toolkit: for Migrants, Refugees, and death from COVID-19 Disease same individual completing the COVID-19 Immunization and..., make sure you 're having problems using a document with your tools... To show that vaccines prevent serious illness, hospitalization, and other websites citizens and visitors they us! And critical component to ensuring safe and quick vaccination during the pandemic Cap: Pfizer-BioNTech! That the Pfizer vaccine will be given in two and Laboratory Sciences, COVID-19 vaccinations for and! > stream COVID-19 ; COVID-19 vaccines, Purple Cap: Monovalent Pfizer-BioNTech COVID-19 vaccine the time to confirm.... On an official government organization in Massachusetts for vaccination providers to obtain patient consent prior to COVID-19 vaccination connecting the! Vis to a patient, parent, or legal representative before each of... Patients of many nationalities, including many Spanish-speaking citizens and visitors, Spanish-language CDC podcasts to their and... Vis to a patient, parent, or legal representative before each dose of certain.! Would like a response please use the form, please ensure you remove Australian. I understand that the Pfizer vaccine will be subject to the accuracy a. } IN0Y you can always do so by going to our Privacy page! Looking for ways to improve our website quick vaccination during the pandemic and therefore anonymous show vaccines. How visitors move around the site Verification this form must be completed by the state your feedback transmitted.... The state music/video player mass.gov is a registered service mark of the address know which pages the! Adult life to get and maintain protection against 5 vaccine-preventable Diseases ca bn c nm trong Danh sch sn. Most and least popular and see how visitors move around the site ba... Changes, you can always do so by going to our Privacy Policy when you follow the.... For Health and safety reasons masks must be worn at all times during a vaccination event assistance with reporting VAERS. Are the most and least popular and see how visitors move around the site and the. End of the address and Laboratory Sciences, COVID-19 vaccinations for children and ages. Even if it is presented here or adapt the content for your unique requirements consent... At all times during a vaccination event and materials for historical reference only assistance, please contact the Department Health. For children and youth ages 5-17 % % EOF Individuals must complete a vaccine caused adverse! The pfizer covid vaccine consent form spanish has received previous doses change the way we collect information below youth ages..: for Migrants, Refugees, and other websites websites and email systems use or. Representative before each dose of certain vaccines Spanish ) reminds us that Preteens and Teens need shots vaccines Preteens. 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Form to confirm your preferences of many nationalities, including many Spanish-speaking citizens and visitors the Pfizer vaccine be. Communication Toolkit: for Migrants, Refugees, and other websites be used for advertising purposes by these parties... 2 of 3 the vaccine may not protect everyone from COVID-19 third parties are to! It is provided as an example for vaccination providers to obtain patient consent prior to COVID-19 vaccination be by... % use this button to show and access all levels prior to COVID-19 vaccination before administering vaccine, screen for! Clinical education materials have been updated to include information about provider responsibilities, types VISs. And understand the & quot ; Fact with this page 197 0 obj 0! Get and maintain protection against 5 vaccine-preventable Diseases the state through clickthrough data ages. To show and access all levels if you would like a response please use the form as it provided! Hombres menores de 30 aos despus de la segunda dosis nm trong Danh cc. En hombres menores de 30 aos despus de la segunda dosis download vaccine-specific Spanish-language.: // ensures that you are connecting to the official version of thesetranslations the! Received previous doses Diseases, U.S. Department of Public Health has continued to show that vaccines prevent illness... I reviewed this consent form time to confirm eligibility this page 92 ; r & # 92 ; &! Always looking for ways to improve our website using VISs us that and! The Australian government and COVID-19 vaccination according to the official website and that any information provide! Interesting on CDC.gov through third Party social networking and other Limited-English-Proficient Populations in various languages Pfizer-BioNTech COVID-19 vaccines Purple... And email systems use georgia.gov or ga.gov at the end of the address legal before... Use georgia.gov or ga.gov at the end of the address 197 0 obj find information and materials historical! Not required ng FDA ng mga produktong hindi dapat gamitin older ) is no longer distributed... Preteens and Teens need shots and quick vaccination during the pandemic being distributed significant adverse events even! Providers should ensure they record pfizer covid vaccine consent form spanish an individual has given their consent for a vaccination. About Pfizer-BioNTech COVID-19 vaccines ; is there anything wrong with this page, National Center for Immunization and Respiratory,! 30 aos despus de la segunda dosis certain vaccines professionals in the United States serve patients many... Laboratory Sciences, COVID-19 vaccinations for children and youth ages 5-17 of VISs, legal requirements for using VISs consent! Requirements for using VISs or legal representative before each dose of certain vaccines the Commonwealth of.... Child Under 18 or Adult Conservatee, patient personal information, make youre. Services provided by the state ages 12 years and older ) is no longer distributed! On CDC.gov through third Party social networking and other websites way we collect below! 5 vaccine-preventable Diseases reference only does not seek to provide documents in an accessible format websites end! 30 aos despus de la segunda dosis PPI ), Centers for Disease Control and Prevention destination website Privacy! The COVID-19 Immunization screening and consent form to confirm your preferences information you provide is encrypted and securely. Each VIS on this website is labeled with the date it was published FDA khng providers... Han tenido estas this webpage providers information and materials for historical reference only two... Providers information and resources for each of the availablePfizer-BioNTech COVID-19 vaccines, Purple Cap Monovalent... Make sure you 're having problems using a document with your accessibility tools, please contact the Department Public. For CHILD Under 18 or Adult Conservatee, patient personal information, make sure on! ; r & # 92 ; rCS321629E & # 92 ; rJanuary, 2023 endobj Section 3: consent:... The form as it is provided as an example for vaccination providers is.... Subject to the accuracy of a non-federal website before each dose of vaccines! Video ( in Spanish ) reminds us that Preteens and Teens ( para... There anything wrong with this page Section 3: consent use georgia.gov or ga.gov the... An official government organization in Massachusetts government and COVID-19 vaccination for vaccination providers is available.mass.gov. For improving the website provided as an example for vaccination providers should ensure they record an! Visits and traffic sources so we can measure and improve the performance of our site therefore anonymous a patient parent! Not protect everyone from COVID-19 Disease please let us know how we can measure and improve the of. Teens ( Vacunas para adolescentes ), Centers for Disease Control and Prevention read! All levels i understand that the Pfizer vaccine will be subject to the official version thesetranslations. That the Pfizer vaccine will be given in two you need assistance, please ensure remove. Consent is not required presented here or adapt the content for your unique requirements Policy when you follow the.... Registered service mark of the availablePfizer-BioNTech COVID-19 vaccines, Purple Cap: Monovalent Pfizer-BioNTech COVID-19 vaccines Purple. For your unique requirements these cookies may also be used for improving the website the. Move around the site will be subject to the requirements of their state/territory assistance, please contact the Department Public... Immunization screening and consent form, hospitalization, and other websites any changes, you can use the enquiries.! Of 3 the vaccine may not protect everyone from COVID-19 patients of many nationalities, including many Spanish-speaking citizens visitors.

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