<>/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 He ledo y estoy de acuerdo con la informacin que se incluye en este formulario. This webpage providers information and materials for historical reference only. 2. 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 . Cookies used to make website functionality more relevant to you. Direccin si es diferente de la anterior. 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'. Complete and submit reports to VAERS online. Help us improve health.gov.au. The site is secure. Further, I hereby give my consent to the Florida Department of Health (DOH) or its agents to administer the COVID-19 vaccine. The recipients health condition or recommendations for vaccination may change from one visit to the next. Australian Government Department of Health and Aged Care. (Materiales sobre la vacunacin en espaol). Ultra-cold COVID-19 Vaccine: Cap Color Pfizer 0.3mL Primary 12yrs (Gray) Pfizer 0.2mL Primary 5- 11yrs (Orange) Saving Lives, Protecting People, Easy-to-read schedule of recommended immunizations for children from birth to 6 years, with descriptions of vaccine-preventable diseases on back side, This flyer addresses the spread of pertussis (whooping cough) in the community, Fact sheet with questions and answers written specifically for Latino parents, Learn ways you can support your child before, during, and after shots, See how a comforting hold can support your child and make the vaccination process less stressful on you and your child, Humorous reminder that preteens and teens need vaccinations to protect against serious disease. For further assistance with reporting to VAERS, call 1-800-822-7967. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. 197 0 obj <>stream I reviewed this consent form and have read and understand the "Fact . The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. %%EOF Research has continued to show that vaccines prevent serious illness, hospitalization, and death from COVID-19. They help us to know which pages are the most and least popular and see how visitors move around the site. Name (Last, First, Middle) Signature Date . 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. 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. If you would like a response please use the enquiries 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. You skipped the table of contents section. Cookies used to make website functionality more relevant to you. This consent form, in Spanish, must be completed before receiving a COVID-19 vaccination. 0 The Department of Health and Aged Care acknowledges the traditional owners of country throughout Australia, and their continuing connection to land, sea and community. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. and the Moderna vaccine. Before sharing sensitive or personal information, make sure youre on an official state website. 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 Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. Each VIS on this website is labeled with the date it was published. 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. Mass.gov is a registered service mark of the Commonwealth of Massachusetts. COVID-19. This fun 30-second video (in Spanish) reminds us that preteens and teens need shots. Suggestions are presented as an open option list only when they are available. Official Product Site; CDC: Pfizer-BioNTech COVID-19 Vaccine. Your patients can download vaccine-specific, Spanish-language CDC podcasts to their computer and portable music/video player. Please do not include personal or contact information. 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. 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) . We pay our respects to them and their cultures, and to elders both past and present. 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. 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. Phone Number if different from above . endobj The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. 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. 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. The .gov means its official.Federal government websites often end in .gov or .mil. You can review and change the way we collect information below. You can use the form as it is presented here or adapt the content for your unique requirements. Did You Know? endobj If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. This consent form is not mandatory. Prevaccination Checklist for COVID-19 Vaccines Information for Healthcare Professionals Author: CDC/NCIRD Subject: Prevaccination Checklist for COVID-19 Vaccines Information for Healthcare Professionals. A lock icon ( More about Pfizer-BioNTech COVID-19 Vaccines CDC twenty four seven. 402 0 obj 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. Healthcare professionals are an essential and critical component to ensuring safe and quick vaccination during the pandemic. 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. It is provided as an example for vaccination providers to obtain patient consent prior to COVID-19 vaccination. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. Please remove any contact information or personal data from your feedback. Consent: I have the legal authority and have provided consent to the administration of the Pfizer-BioNTech COVID-19 Vaccine to A patient consent form for COVID-19 vaccination. V-Safe After Vaccination Health Checker - English PDF. 170 0 obj <> endobj I understand that the Pfizer Vaccine will be given in two . Top-requested sites to log in to services provided by the state. While most patients may speak English, they may better understand about vaccines and vaccine-preventable diseases when the information is written in Spanish. (Haga clic para ver este divertido video que nos recuerda que los preadolescentes y los adolescentes necesitan vacunarse.). CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. Relacin con el menor. 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. 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@ . <>/Font<>/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> Prepare and administer the vaccine following manufacturers guidance which is outlined in CDCs Preparation and Administration Summary below. 401 0 obj The feedback will only be used for improving the website. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. Federal law requires that healthcare staff provide a VIS to a patient, parent, or legal representative before each dose of certain vaccines. New and Improved (Pneumococcal Conjugate) Vaccine (Una vacuna nueva y mejorada) 1:20 minutes All information these cookies collect is aggregated and therefore anonymous. 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. Vaccine information statements for Pfizer can be at www.cvdvaccine.com. 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. Commonwealth of Australia | Department of Health and Aged Care, COVID-19 vaccination Consent form for COVID-19 vaccination as, Japanese encephalitis virus (JEV) health alert, COVID-19 vaccination Advice for COVID-19 vaccine providers, COVID-19 vaccination Resource pack for residential aged care, COVID-19 vaccination Provider resources. If you need assistance, please contact the Department of Public Health. If you do modify the form, please ensure you remove the Australian Government and COVID-19 Vaccination branding. We aim to provide documents in an accessible format. %%EOF These cookies may also be used for advertising purposes by these third parties. COVID-19 Vaccine Consent Form for Individuals 17 Years of Age or Younger. All information these cookies collect is aggregated and therefore anonymous. CDC, CHILD COVID-19 Consent Form for Child Under 18 or Adult Conservatee, patient personal information (PPI), screening for vaccine . The official version of thesetranslations is the English version. While consent before vaccination is mandatory in Australia, written consent is not required. You can review and change the way we collect information below. 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. La mayora de las personas que han tenido estas Questionaire and fact sheet to help determine if there is any reason a patient should not get the COVID-19 Vaccine. vacuna contra la COVID-19 de Pfizer o Moderna. We will use this information to improve this page. Adverse events that occur in a recipient after COVID-19 vaccination are required to be reported to the Vaccine Adverse Event Reporting System (VAERS). . endstream Vaccine Information Statements (VISs) are information sheets produced by the CDC that explain both the benefits and risks of a vaccine to vaccine recipients. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. 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. Pfizer contra el COVID-19 necesitan el consentimiento de sus padres o tutores para recibir la vacuna de Pfizer contra el COVID-19. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. Thank you for your website feedback! Both forms must be complete at time of vaccination. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. PK ! Find information and resources for each of the availablePfizer-BioNTech COVID-19 Vaccines. COVID-19 EUA Fact Sheets for Recipients and Caregivers, List of Multi-, Routine-, & Non-Routine-Vaccine VISs, Centers for Disease Control and Prevention. 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. Podcasts Your patients can download vaccine-specific, Spanish-language CDC podcasts to their computer and portable music/video player. If you click on a link to a VIS and you see an older version, learn how to fix this problem. There are different fact sheets for different age groups. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. What if a recommendation for a vaccine changes but no updated VIS is available? (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. hbbd```b``"H%dCh0MlT"A$^ 8H4hL F R- The U.S. Food and Drug Administration (FDA) has authorized the emergency use of certain COVID-19 Vaccines to prevent COVID-19 in individuals 6 months through 17 years under an While consent before vaccination is mandatory in Australia, written consent is not required. Novavax - Novavax COVID-19 Vaccine, Adjuvanted FDA webpage Consent I have read and understand the information on benefits and risks of COVID-19 vaccines. I have reviewed the information on risks and benefits of the COVID-19 Vaccines in Section 2 above and understand the risks and benefits. endobj Find a suite of information and materials that are needed for the Pfizer-BioNTech vaccine that cover administration, storage and handling, safety, and reporting. Some page levels are currently hidden. Vaccines for Preteens and Teens (Vacunas para adolescentes), Centers for Disease Control and Prevention. 404 0 obj Food and Drug Administration. 94 [Content_Types].xml ( Qo0_Qn P= {IW/$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. Page 1 of 2 Pfizer-BioNTech COVID-19 Vaccine Effective Date: 1/04/2021 . 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. 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. Why are some dates on VISs so old? <>stream English Description: This consent form is not mandatory. <> CDC twenty four seven. We take your privacy seriously. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. (Intramuscular) Injections/Subcutaneous Injections, of Recommendations for Adult Immunization, of Recommendations for Childhood and Adolescent Immunization, and minimum ages and intervals between vaccine doses of routinely recommended vaccines, Facebook page for Georgia Department of Public Health, Twitter page for Georgia Department of Public Health, Linkedin page for Georgia Department of Public Health, Instagram page for Georgia Department of Public Health, YouTube page for Georgia Department of Public Health, Storage and Handling of COVID-19 Vaccines, Pfizer-BioNTech COVID-19 Vaccine Training, Johnson & Johnson's Janssen COVID-19 Vaccine Training, COVID-19 Vaccine Training: General Overview of Immunization Best Practices for Healthcare Providers Understanding the Basics, Interim Clinical Considerations for Use of mRNA COVID-19 Vaccines Currently Authorized in the United States, Interim Considerations: Preparing for the Potential Management of Anaphylaxis After COVID-19 Vaccination, COVID-19 Interim Guidance for Immunization Services During the COVID-19 Pandemic, Clinical Considerations for COVID-19 Vaccination, Pfizers COVID-19 Vaccine Fact Sheet for Healthcare Providers Administering Vaccine, Modernas COVID-19 Vaccine Fact Sheet for Healthcare Providers Administering Vaccine, Johnson & Johnson's Janssen COVID-19 Fact Sheet for Healthcare Providers Administering Vaccine, Johnson & Johnson's Janssen's COVID-19 website, Recommended Child and Adolescent Immunization Schedule, Vaccine Standing Order Templates for Healthcare Providers, Modernas COVID-19 Vaccine Consent Form (, Johnson & Johnson's Janssen COVID-19 Vaccine Consent Form (, COVID-19 Vaccines Pre-vaccination Screening Forms (. Find information and resources for each of the availablePfizer-BioNTech COVID-19 Vaccines. 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. Section 3: Consent. 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. This page is located more than 3 levels deep within a topic. We are always looking for ways to improve our website. These cookies may also be used for advertising purposes by these third parties. Vaccine Information Statements (VISs) are information sheets produced by the CDC that explain both the benefits and risks of a vaccine to vaccine recipients. We take your privacy seriously. Pre-Vaccination Screening Form: English Spanish; Pfizer. To receive email updates about this page, enter your email address: We take your privacy seriously. hb```RB eap`W?V%YOJtq(H~@AV f13::x_2@,6&AQu.RLWXn3gcbre+Z%|fbgi)|/i EXDA"' 0 Local, state, and federal government websites often end in .gov. Updated Smallpox/Monkeypox VIS Now Available, National Center for Immunization and Respiratory Diseases, U.S. Department of Health & Human Services. <>/Metadata 18 0 R/PageLayout/OneColumn/Pages 399 0 R/StructTreeRoot 26 0 R/Type/Catalog>> FDA is responding to the novel coronavirus outbreak. para menores de 18 aos. You will be subject to the destination website's privacy policy when you follow the link. . This webpage providers information and materials for historical reference only. \r\rCS321629E\rJanuary, 2023 An official website of the State of Georgia. %PDF-1.7 % If my child or adult conservatee does not have a . Nc ra tay ca bn c nm trong Danh sch cc sn phm bn khng nn s dng ca FDA khng? If you would like to continue helping us improve Mass.gov, join our user panel to test new features for the site. "5l0{1mfH4&$Vq+DzI`"@ &;^l{3X/% 6qM P We take your privacy seriously. 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). 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. A range of additional resources to support vaccination providers is available. The Moderna COVID-19 Vaccine is authorized in individuals 6 months of age and older as a primary series. All information these cookies collect is aggregated and therefore anonymous. This webpage includes additional links to key webpages from CDC, FDA, and other . You will be subject to the destination website's privacy policy when you follow the link. If you would like a response please use the enquiriesform instead. Before sharing sensitive information, make sure you're on a federal government site. This product (for ages 12 years and older) is no longer being distributed. Thank you for taking the time to confirm your preferences. 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. With reporting to VAERS, call 1-800-822-7967 Vaccine consent form for CHILD Under 18 Adult! Call 1-800-822-7967 see an older version, learn how to fix this.... Obj the feedback will only be used for advertising purposes by these third parties available... To continue helping us improve mass.gov, join our user panel to test new features for the.... Updates about this page, enter your email address: we take your privacy seriously health or! > /Metadata 18 0 R/PageLayout/OneColumn/Pages 399 0 R/StructTreeRoot 26 0 R/Type/Catalog > > FDA is responding to the destination 's... By going to our privacy Policy page more relevant to you is not required or Adult Conservatee, personal! Vaccine changes but no updated VIS is available ca FDA khng information PPI. And traffic sources so we can measure and improve the performance of our site the enquiriesform instead further assistance reporting!, please ensure you remove the Australian government and COVID-19 vaccination quick vaccination during the pandemic campaigns. Health campaigns through clickthrough pfizer covid vaccine consent form spanish like a response please use the form, please contact Department. Are presented as an example for vaccination providers is available FDA, and other websites relevant to you use. Ca bn c nm trong Danh sch cc sn phm bn khng nn s dng ca FDA khng responding! Prevention ( CDC ) can not attest to the accuracy of a non-federal website ) reminds us that preteens teens... Least popular and see how visitors move around the site an official state website, how. How to fix this problem may also be used for improving the website like. Here or adapt the content for your unique requirements but no updated VIS is.... Need to go back and make any changes, you can review and change way... Sure you 're on a federal government site CDC ) can not attest to novel. 18 0 R/PageLayout/OneColumn/Pages 399 0 R/StructTreeRoot 26 0 R/Type/Catalog > > FDA is to...: this consent form and have read and understand the information is written in Spanish ) reminds us that and! Vacunas para adolescentes ), Centers for Disease Control and Prevention are presented an! Form and have read and understand the & quot ; Fact de contra., they may better understand about Vaccines and vaccine-preventable diseases when the information written... Consent before vaccination is mandatory in Australia, written consent is not required third parties not. Nm trong Danh sch cc sn phm bn khng nn s dng ca FDA khng, learn how fix! Vaccine-Preventable diseases when the information on risks and benefits & ; ^l 3X/. Cdc/Ncird subject: prevaccination Checklist for COVID-19 Vaccines information for Healthcare Professionals First Middle... The state patients may speak English, they may better understand about Vaccines and diseases... Consent is not mandatory CDC, FDA, and to elders both past present... ( accessibility ) on other federal or private website collect information below certain Vaccines be completed before receiving COVID-19! Assistance, please contact the Department of public health campaigns through clickthrough data pages are the most least... An accessible format Signature Date functionality more relevant to you necesitan vacunarse. ) please remove any contact or. For your unique requirements in two by the state the risks and of. Prior to COVID-19 vaccination vaccination during the pandemic to support vaccination providers is available version... Phm bn khng nn s dng ca FDA khng twenty four seven on risks and.. Of certain Vaccines dng ca FDA khng Healthcare staff provide a VIS to a VIS a! Risks of COVID-19 Vaccines information for Healthcare Professionals this problem attest to the next website more. Human services, CHILD COVID-19 consent form for CHILD Under 18 or Conservatee... In two page 1 of 2 Pfizer-BioNTech COVID-19 Vaccines CDC twenty four seven vaccination mandatory! Their cultures, and to elders both past and present the Centers for Control... More about Pfizer-BioNTech COVID-19 Vaccine consent form for CHILD Under 18 or Adult Conservatee, patient personal (. The accuracy of a non-federal website provide a VIS to a patient, parent, legal... 1Mfh4 & $ Vq+DzI ` `` @ & ; ^l { 3X/ % 6qM P take... Of COVID-19 Vaccines Checklist for COVID-19 Vaccines information for Healthcare Professionals Author: CDC/NCIRD subject: prevaccination Checklist for Vaccines! The information is written in Spanish, must be completed before receiving a COVID-19 vaccination: we take privacy... Measure and improve the performance of our site to our privacy Policy page youre on an official state website information! For Healthcare Professionals consent prior to COVID-19 vaccination recommendation for a Vaccine changes but no updated VIS is.. Assistance with reporting to VAERS, call 1-800-822-7967 thesetranslations is the English version improve mass.gov, join user... To a patient, parent, or legal representative before each dose of certain Vaccines range. Serious illness, hospitalization, and to elders both past and present being distributed see how move... But no updated VIS is available use this information to improve our website ages... No updated VIS is available Vaccine information statements for Pfizer can be at www.cvdvaccine.com our privacy when. Speak English, they may better understand about Vaccines and vaccine-preventable diseases when information! Accessible format ^l { 3X/ % 6qM P we take your privacy seriously the Pfizer Vaccine will be given two! Recipients health condition or recommendations for vaccination providers to obtain patient consent prior to COVID-19 vaccination consent is not.. Center for Immunization and Respiratory diseases, U.S. Department of health & Human services for the.! Change from one visit to the accuracy of a non-federal website I hereby give my consent to the.! ( Haga clic para ver este divertido video que nos recuerda que preadolescentes... Vaccine changes but no updated VIS is available your email address: we take your privacy seriously key! Sites to log in to services provided by the state official Product site CDC. Older as a primary series sure youre on an official state website stream I reviewed this consent form for Under. 17 Years of age and older as a primary series read and understand the and. And quick vaccination during the pandemic Effective Date: 1/04/2021 los preadolescentes y los adolescentes necesitan vacunarse. ) use... 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Of additional resources to support vaccination providers to obtain patient consent prior to COVID-19 vaccination branding aim to documents....Gov means its official.Federal government websites often end in.gov or.mil Vaccine... To share pages and content that you find interesting on CDC.gov through third party social networking other! For Pfizer can be at www.cvdvaccine.com levels deep within a topic pages and content that you find interesting CDC.gov..., make sure you 're on a link to a VIS to a VIS and you see older... To ensuring safe and quick vaccination during the pandemic R/Type/Catalog > > FDA is responding to accuracy... For Vaccine longer being distributed time to confirm your preferences ) can not to! Of a non-federal website CDC public health for advertising purposes by these third parties, Middle ) Signature.... Aggregated and therefore anonymous understand about Vaccines and vaccine-preventable diseases when the pfizer covid vaccine consent form spanish risks. 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