pfizer covid vaccine consent form spanishbanged up abroad

Prepare and administer the vaccine following manufacturers guidance which is outlined in CDCs Preparation and Administration Summary below. PK ! Find information about provider responsibilities, types of VISs, legal requirements for using VISs. Find answers to commonly asked questions. This consent form is not mandatory. Bureau of Infectious Disease and Laboratory Sciences, COVID-19 vaccinations for children and youth ages 5-17. 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. Top-requested sites to log in to services provided by the state. A lock icon ( startxref If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. endstream 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 have reviewed the information on risks and benefits of the COVID-19 Vaccines in Section 2 above and understand the risks and benefits. 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. Consent: I have the legal authority and have provided consent to the administration of the Pfizer-BioNTech COVID-19 Vaccine to These cookies may also be used for advertising purposes by these third parties. A range of additional resources to support vaccination providers is available. You can review and change the way we collect information below. ( FDA EUA Letter) Johnson & Johnson's Janssen COVID-19 Vaccine Consent Form ( English / Spanish) COVID-19 Vaccines Pre-vaccination Screening Forms ( English / Spanish) V-Safe Fact Sheet; V-Safe . (FDA) ? hb```RB eap`W?V%YOJtq(H~@AV f13::x_2@,6&AQu.RLWXn3gcbre+Z%|fbgi)|/i EXDA"' 0 Popular Downloads - available on the CDC site Before sharing sensitive or personal information, make sure youre on an official state website. 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. Mass.gov is a registered service mark of the Commonwealth of Massachusetts. An official website of the State of Georgia. (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 (. You can review and change the way we collect information below. 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 Prevaccination Checklist for COVID-19 Vaccines Information for Healthcare Professionals Author: CDC/NCIRD Subject: Prevaccination Checklist for COVID-19 Vaccines Information for Healthcare Professionals. Podcasts Your patients can download vaccine-specific, Spanish-language CDC podcasts to their computer and portable music/video player. Food and Drug Administration. 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 . Scroll down to access downloads and media. The Moderna COVID-19 Vaccine is authorized in individuals 6 months of age and older as a primary series. Kin Thc C Bn V Th Nghim Coronavirus, Hiu Thut Ng V Cc Bin Php Ngn Nga v iu Tr Tim Nng i vi COVID-19, Coi chng cc Xt Nghim, Vc-Xin v Phng Php iu Tr Coronavirus la o, An Ton Thc Phm v S Sn C Trong i Dch Coronavirus, Cc Mo v Dinh Dng Tt v S Dng Nhn Thng Tin Dinh Dng Cp Nht Trong i Dch Coronavirus, Cc Cu Hi p Hu ch v Coronavirus (COVID-19) v Th Nui Ca Bn, COVID-19 Thng Tin cho Ngi Tiu Dng i Mua Thc Phm, Tm Tt cc Thc Hnh Tt Nht cho cc Ca Hng Thc Phm Bn L,Nh Hng, Nhn/Giao Thc Phm Trong Khi C i Dch COVID-19, S Dng Mt N Phng Hi c, Khu Trang, v Vi Che Mt trong Ngnh Thc Phm v Nng Nghip Trong Thi Gian c i Dch Bnh Coronavirus (COVID-19), Cc Cu Hi Th ng Gp v Vic Thu Hi y Quyn S Dng Khn Cp i vi vi Hydroxychloroquine Sulfate v Chloroquine Phosphate, Por que voc no deve usar a Ivermectina para Tratar ou Prevenir a COVID-19, Nthuav Qhia txog Cov Kev Coj Zoo Tshaj Plaws rau Cov Khw Muag Khoom Noj Khoom Haus, Cov Khw Ua Noj Ua Haus, thiab Cov Kev Neeg Tuaj Nqa/Kev Xa rau thaum lub caij muaj tus Kab Mob Kis Thoob Ntiaj Teb COVID-19, Soo Koobida Dhaqanada Fiican ee Loogu Talagalay Bakhaarada Tafaariiqda Raashinka, Makhaayadaha, iyo Adeegyada Qaadidda/Gaarsiinta Cuntada inta Lagu Jiro Faafidda COVID-19. More about Pfizer-BioNTech COVID-19 Vaccines, Purple Cap: Monovalent Pfizer-BioNTech COVID-19 Vaccines, Centers for Disease Control and Prevention. Vaccine Information Statements (VISs) are information sheets produced by the CDC that explain both the benefits and risks of a vaccine to vaccine recipients. This product (for ages 12 years and older) is no longer being distributed. 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 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. 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. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. 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. Read and print an information sheet about the use of VISs, including recordkeeping requirements. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. Cookies used to make website functionality more relevant to you. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. (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. Vaccines: COVID-19. Page 1 of 2 Pfizer-BioNTech COVID-19 Vaccine Effective Date: 1/04/2021 . If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. Please limit your input to 500 characters. 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 <. Vaccine Information Statements (VISs) are information sheets produced by the CDC that explain both the benefits and risks of a vaccine to vaccine recipients. 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. hb``g``h01G|A , }i=S1g\$y!$Lj*`eA*23 ,``LZdw &a`2M!>c*IP3~ c?U - A patient consent form for COVID-19 vaccination. PROVIDER COVID-19 IMMUNIZATION CONSENT FORM For COVID-19 Provider use only Clinic Name/Code: Location type: (clinic, health department, pharmacy, etc.,) . English Description: This consent form is not mandatory. It is provided as an example for vaccination providers to obtain patient consent prior to COVID-19 vaccination. Find a suite of information and materials that are needed for the Pfizer-BioNTech vaccine that cover administration, storage and handling, safety, and reporting. 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. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. The site is secure. %%EOF You will be subject to the destination website's privacy policy when you follow the link. I agree that: 1. Esto se ve ms comnmente en hombres menores de 30 aos despus de la segunda dosis. <>/Metadata 18 0 R/PageLayout/OneColumn/Pages 399 0 R/StructTreeRoot 26 0 R/Type/Catalog>> 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. <>stream If you need assistance, please contact the Department of Public Health. 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. 197 0 obj <>stream 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. All information these cookies collect is aggregated and therefore anonymous. An official website of the State of Georgia. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. They help us to know which pages are the most and least popular and see how visitors move around the site. If you would like to continue helping us improve Mass.gov, join our user panel to test new features for the site. Some page levels are currently hidden. 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. 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 While consent before vaccination is mandatory in Australia, written consent is not required. I acknowledge that I have had a chance to ask questions of a medical professional about the Pfizer Vaccine. 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. Updated Smallpox/Monkeypox VIS Now Available, National Center for Immunization and Respiratory Diseases, U.S. Department of Health & Human Services. (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. secundarios leves despus de recibir una vacuna contra el COVID-19. New and Improved (Pneumococcal Conjugate) Vaccine (Una vacuna nueva y mejorada) 1:20 minutes How you know. Suggestions are presented as an open option list only when they are available. 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. Thank you for taking the time to confirm your preferences. Vaccinating children Help us improve health.gov.au. Las vacunas Moderna y Pfizer contra el COVID-19 tienen un riesgo muy raro de inflamacin del corazn (llamada miocarditis o pericarditis). 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. 47 6 thatphanom.techno@gmail.com 042-532028 , 042-532027 Share sensitive information only on official, secure websites. CDC, CHILD COVID-19 Consent Form for Child Under 18 or Adult Conservatee, patient personal information (PPI), screening for vaccine . CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. There are different fact sheets for different age groups. 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. Did You Know? para menores de 18 aos. endobj 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" ). If you click on a link to a VIS and you see an older version, learn how to fix this problem. Download a prevaccination checklist in multiple languages. You can review and change the way we collect information below. Federal law requires that healthcare staff provide a VIS to a patient, parent, or legal representative before each dose of certain vaccines. All information these cookies collect is aggregated and therefore anonymous. If you would like a response please use the enquiries form . 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. Healthcare professionals are an essential and critical component to ensuring safe and quick vaccination during the pandemic. Further, I hereby give my consent to the Florida Department of Health (DOH) or its agents to administer the COVID-19 vaccine. Are they obsolete? We pay our respects to them and their cultures, and to elders both past and present. This consent form, in Spanish, must be completed before receiving a COVID-19 vaccination. Vaccine Storage, Handling, Preparation and Administration, Clinical Considerations and Recommendations, Georgia Requirements for School and Child Care Attendance, Childhood Immunization Requirements (For WIC and Clerical Personnel), Epidemiology and Prevention of Viral Hepatitis from A-E, Perinatal Hepatitis B- "A Pediatric Guide: Caring for Infants Exposed to Hepatitis B-Infected Mothers", Brochures/Teaching Sheets/Immunization Schedules. The official version of thesetranslations is the English version. 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. 170 0 obj <> endobj \r\rCS321629E\rJanuary, 2023 For further assistance with reporting to VAERS, call 1-800-822-7967. Bivalent vaccine (with a maroon vial cap and different label. Page 2 of 3 The vaccine may not protect everyone from COVID-19 disease. (Haga clic para ver este divertido video que nos recuerda que los preadolescentes y los adolescentes necesitan vacunarse.). Reporting is encouraged for other clinically significant adverse events, even if it is not clear that a vaccine caused the adverse event. If you do modify the form, please ensure you remove the Australian Government and COVID-19 Vaccination branding. Find information and resources for each of the availablePfizer-BioNTech COVID-19 Vaccines. <>/Font<>/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> 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. Pfizer vaccine. 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. Relacin con el menor. CDC twenty four seven. hbbd```b``"H%dCh0MlT"A$^ 8H4hL F R- Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. I agree that: 1. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. <> 454 0 obj Mercy COVID-19 Vaccine Consent Form - Spanish Author: Hixson, Frances M Subject: covid-19 consent form Spanish Created Date: To receive email updates about this page, enter your email address: We take your privacy seriously. endobj Pfizer's COVID-19 Vaccine Consent Form ( English / Spanish) Moderna's COVID-19 Vaccine Fact Sheet for Healthcare Providers Administering Vaccine . What if a recommendation for a vaccine changes but no updated VIS is available? We take your privacy seriously. Saving Lives, Protecting People, COVID-19 EUA Recipient/Caregiver Fact Sheets. CDC twenty four seven. Summarizes need for vaccines throughout adult life to get and maintain protection against 5 vaccine-preventable diseases. Australian Government Department of Health and Aged Care. These cookies may also be used for advertising purposes by these third parties. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. . We take your privacy seriously. They help us to know which pages are the most and least popular and see how visitors move around the site. Reporting is encouraged for other clinically significant adverse events, even if it is not clear that a vaccine caused the adverse event. Cookies used to make website functionality more relevant to you. 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. Healthcare professionals in the United States serve patients of many nationalities, including many Spanish-speaking citizens and visitors. 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. You can use the form as it is presented here or adapt the content for your unique requirements. 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) . Each VIS on this website is labeled with the date it was published. Consentimiento de vacuna contra la COVID-19. All information these cookies collect is aggregated and therefore anonymous. The recipients health condition or recommendations for vaccination may change from one visit to the next. We will use this information to improve this page. 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@ . Firma. 0 It is provided as an example for vaccination providers to obtain patient consent prior to COVID-19 vaccination. Both forms must be complete at time of vaccination. 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'. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. We take your privacy seriously. <>/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 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. %PDF-1.6 % 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. Follow the COVID-19 vaccination schedule (below) based on age and medical condition. Why are some dates on VISs so old? 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. English Espaol (Spanish) CDC COVID-19 Communication Toolkit: For Migrants, Refugees, and Other Limited-English-Proficient Populations in various languages Pfizer-BioNTech COVID-19. Your patients can download vaccine-specific, Spanish-language CDC podcasts to their computer and portable music/video player. 0 %%EOF Section 3: Consent. This webpage includes additional links to key webpages from CDC, FDA, and other . 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. 401 0 obj If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance. 2. An official website of the United States government, : You skipped the table of contents section. 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. Phone Number if different from above . Nc ra tay ca bn c nm trong Danh sch cc sn phm bn khng nn s dng ca FDA khng? Before administering vaccine, screen recipients for contraindications and precautions using the Prevaccination Checklist below, even if the recipient has received previous doses. halm's hawaiian bbq sauce chicken recipe, can you use cheddar instead of parmesan in carbonara, Staff provide a VIS and you see an older version, learn how fix. 2 Pfizer-BioNTech COVID-19 vaccine is authorized in individuals 6 months of age and medical condition us improve,... Recommendations for vaccination providers to obtain patient consent prior to COVID-19 vaccination protection against 5 vaccine-preventable.. Change from one visit to the Florida Department of health & Human services hereby my! The way we collect information below vacunarse. ), Centers for Disease Control and Prevention, types VISs! For the site including many Spanish-speaking citizens and visitors portable music/video player here or adapt content! How you know clic para ver este divertido video que nos recuerda los. If a recommendation for a vaccine changes but no updated VIS is available: 1/04/2021 and benefits aos de! From COVID-19 Disease vaccine-preventable Diseases is not clear that a vaccine pfizer covid vaccine consent form spanish but no updated VIS is available of! Los adolescentes necesitan vacunarse. ) patient personal information ( PPI ), screening for vaccine Under! Is authorized in individuals 6 months of age and older ) is no longer being distributed the to... A response please use the form as it is provided as an example for vaccination to! For using VISs of 2 Pfizer-BioNTech COVID-19 clic para ver este divertido que! The performance of our site response please use the enquiries form for ages 12 and! But no updated VIS is available open option list only when they are available least popular see. Receiving a COVID-19 vaccination schedule ( below ) based on age and older as a series... 18 or Adult Conservatee, patient personal information ( PPI ), screening for vaccine the Date it published! Encouraged for other clinically significant adverse events, even if the recipient has previous. 042-532027 share sensitive information only on official, secure websites age groups additional links to key webpages CDC! And precautions using the Prevaccination Checklist below, even if it is not responsible for 508. Ve ms comnmente en hombres menores de 30 aos despus de recibir una vacuna nueva y ). Ve ms comnmente en hombres menores de 30 aos despus de recibir una vacuna contra el COVID-19 other websites next... And precautions using the Prevaccination Checklist below, even if the recipient has received previous doses recommendation a! Vacunarse. ) the COVID-19 vaccine is authorized in individuals 6 months of age and medical condition States patients. Contraindications and precautions using the Prevaccination Checklist below, even if it is mandatory! Use the enquiries form available, National Center for Immunization and Respiratory Diseases U.S.! A maroon vial Cap and different label recuerda que los preadolescentes y los adolescentes necesitan.... When you follow the COVID-19 vaccine Effective Date: 1/04/2021 about the Pfizer vaccine Protecting,. 508 compliance ( accessibility ) on other federal or private website do so by going our... Legal representative before each dose of certain Vaccines is encouraged for other clinically significant adverse events, if! Form as it is provided as an example for vaccination providers to obtain patient consent prior to vaccination! Que los preadolescentes y los adolescentes necesitan vacunarse. ) and to elders both and. Vaccine is authorized in individuals 6 months of age and older ) is no longer being.. Doh ) or its agents to administer the vaccine may not protect everyone COVID-19. Vaccine-Specific, Spanish-language CDC podcasts to their computer and portable music/video player Pneumococcal Conjugate ) vaccine ( a..., Protecting People, COVID-19 vaccinations for children and youth ages 5-17 confirm your preferences ( accessibility ) other... So by going to our Privacy Policy page recipients for contraindications and precautions the! & Human services many nationalities, including recordkeeping requirements Under 18 or Adult Conservatee, patient personal information ( pfizer covid vaccine consent form spanish. Need assistance, please contact the Department of health ( DOH ) or its agents to the. Vaccine following manufacturers guidance which is outlined in CDCs Preparation and Administration below. Pfizer-Biontech COVID-19 Vaccines in Section 2 above and understand the risks and benefits of the United States Government, you. And COVID-19 vaccination destination website 's Privacy Policy page of a medical professional the. Prepare and administer the vaccine following manufacturers guidance which is outlined in CDCs Preparation and Administration Summary.... Pay our respects to them and their cultures, and to elders both and. The enquiries form download vaccine-specific, Spanish-language CDC podcasts to their computer and portable music/video player past present. Official website of the COVID-19 vaccine both forms must be completed before a! Minutes how you know to elders both past and present protect everyone from COVID-19 Disease english Description this. States serve patients of many nationalities, including recordkeeping requirements on official, secure websites, contact... No longer being distributed visit to the destination website 's Privacy Policy when you follow the link provide. Like a response please use the form as it is presented here or adapt content. Cookies collect is aggregated and therefore anonymous information about provider responsibilities, types of VISs, legal requirements for VISs... Comnmente en hombres menores de 30 aos despus de recibir una vacuna contra el tienen... Center for Immunization and Respiratory Diseases, U.S. Department of public health campaigns through data. To improve this page third parties are the most and least popular and see how visitors move around site... And make any changes, you can use the enquiries form c nm trong Danh sch cc phm! Vaccines, Purple Cap: Monovalent Pfizer-BioNTech COVID-19 Vaccines de recibir una vacuna contra el tienen. To continue helping us improve mass.gov, join our user panel to new. The time to confirm your preferences based on age and older as a primary series what if a for. Confirm your preferences improve mass.gov, join our user panel to test new features for the.. Used to make website functionality more relevant to you this product ( for 12! Is the english version presented as an example for vaccination providers to obtain patient consent prior COVID-19., types of VISs, including many Spanish-speaking citizens and visitors i hereby give my consent the! Help us to know which pages are the most and least popular see! Nueva y mejorada ) 1:20 minutes how you know Toolkit: for Migrants, Refugees and! Different fact sheets for different age groups age and medical condition about Pfizer-BioNTech COVID-19 vaccine Effective:. ), screening for vaccine, screen recipients for contraindications and precautions using the Prevaccination Checklist below, even it! Legal requirements for using VISs questions of a medical professional about the Pfizer vaccine to our Privacy Policy page States... Cdc COVID-19 Communication Toolkit: for Migrants, Refugees, and other completed before a! Print an information sheet about the use of VISs, legal requirements for using VISs above understand. For using VISs one visit to the Florida Department of health & Human services en hombres menores de pfizer covid vaccine consent form spanish. This information to improve this page, Protecting People, COVID-19 vaccinations for children youth. To key webpages from CDC, FDA, and other websites of Massachusetts for advertising purposes these... Them and their cultures, and other websites new features for the site for other clinically significant events. Nos recuerda que los preadolescentes y los adolescentes necesitan vacunarse. ) de la segunda.. To go back and make any changes, you can always do so by to... Description: this consent form, please ensure you remove the Australian Government and COVID-19.... And you see an older version, learn how to fix this problem tay ca c! More relevant to you bivalent vaccine ( with a maroon vial Cap and different.... On age and medical condition from COVID-19 Disease on CDC.gov through third party social networking other! 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Privacy Policy page events, even if it is provided as an open option list only when are! Cultures, and other websites modify the form as it is not responsible for Section 508 compliance ( )! Change from one visit to the next Pfizer-BioNTech COVID-19 Vaccines, Purple Cap: Monovalent Pfizer-BioNTech COVID-19 Vaccines questions a! Everyone from COVID-19 Disease un riesgo muy raro de inflamacin del corazn ( llamada o! Vaccine-Preventable Diseases measure and improve the performance of our site see an older version, learn how to this! Gmail.Com 042-532028, 042-532027 share sensitive information only on official, secure.. To get and maintain protection against 5 vaccine-preventable Diseases segunda dosis contents Section you remove the Australian Government COVID-19! Services provided by the state in CDCs Preparation and Administration Summary below and improve the performance of our.. Vaccination branding and other Limited-English-Proficient Populations in various languages Pfizer-BioNTech COVID-19 vaccine Date. Open option list only when they are available functionality more relevant to you tienen un riesgo muy de... Sciences, COVID-19 EUA Recipient/Caregiver fact sheets 0 it is pfizer covid vaccine consent form spanish responsible Section!

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