pfizer covid vaccine consent form spanishpfizer covid vaccine consent form spanish

If you do modify the form, please ensure you remove the Australian Government and COVID-19 Vaccination branding. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. If you're having problems using a document with your accessibility tools, please contact us for help. Research has continued to show that vaccines prevent serious illness, hospitalization, and death from COVID-19. 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 . <>stream 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. Questionaire and fact sheet to help determine if there is any reason a patient should not get the COVID-19 Vaccine. 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. endobj 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 click on a link to a VIS and you see an older version, learn how to fix this problem. (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 (. To support COVID-19 vaccination efforts nationwide, many healthcare professionals are needed, and therefore, it is crucial that they receive the necessary training to meet the demands of their roles. 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. We will use this information to improve this page. You will be subject to the destination website's privacy policy when you follow the link. This product (for ages 12 years and older) is no longer being distributed. You can review and change the way we collect information below. endobj Nmero de telfono si es diferente del anterior. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. When do we have to start using a new VIS? 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. 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 FDA is responding to the novel coronavirus outbreak. hbbd```b``"H%dCh0MlT"A$^ 8H4hL F R- 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" ). These cookies may also be used for advertising purposes by these third parties. I agree that: 1. We aim to provide documents in an accessible format. and the Moderna vaccine. 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. We hope that you find these translations useful. I acknowledge that I have had a chance to ask questions of a medical professional about the Pfizer Vaccine. If you need assistance, please contact the Department of Public Health. Ultra-cold COVID-19 Vaccine: Cap Color Pfizer 0.3mL Primary 12yrs (Gray) Pfizer 0.2mL Primary 5- 11yrs (Orange) . This consent form is not mandatory. Esto se ve ms comnmente en hombres menores de 30 aos despus de la segunda dosis. You will be subject to the destination website's privacy policy when you follow the link. Summarizes need for vaccines throughout adult life to get and maintain protection against 5 vaccine-preventable diseases. I agree that: 1. 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. It is provided as an example for vaccination providers to obtain patient consent prior to COVID-19 vaccination. If you would like a response please use the enquiries form . You will be subject to the destination website's privacy policy when you follow the link. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. Complete and submit reports to VAERS online. Some page levels are currently hidden. I understand that the Pfizer Vaccine will be given in two . Name (Last, First, Middle) Signature Date . Federal law requires that healthcare staff provide a VIS to a patient, parent, or legal representative before each dose of certain vaccines. 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 <. Please limit your input to 500 characters. Thank you for taking the time to confirm your preferences. Both forms must be complete at time of vaccination. There are different fact sheets for different age groups. All information these cookies collect is aggregated and therefore anonymous. "5l0{1mfH4&$Vq+DzI`"@ &;^l{3X/% 6qM P 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 endstream Reporting is encouraged for other clinically significant adverse events, even if it is not clear that a vaccine caused the adverse event. English Description: This consent form is not mandatory. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. Use this button to show and access all levels. endobj New and Improved (Pneumococcal Conjugate) Vaccine (Una vacuna nueva y mejorada) 1:20 minutes This webpage providers information and materials for historical reference only. (FDA) ? More about Pfizer-BioNTech COVID-19 Vaccines, Purple Cap: Monovalent Pfizer-BioNTech COVID-19 Vaccines, Centers for Disease Control and Prevention. This form does not seek to provide information on ensuring safe vaccination practice. 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). If my child or adult conservatee does not have a . If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. Please remove any contact information or personal data from your feedback. (Check back as we will continue to. endobj Vaccine Information Statements (VISs) are information sheets produced by the CDC that explain both the benefits and risks of a vaccine to vaccine recipients. Cookies used to make website functionality more relevant to you. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. <> What if a recommendation for a vaccine changes but no updated VIS is available? Consent: I have the legal authority and have provided consent to the administration of the Pfizer-BioNTech COVID-19 Vaccine to What are VISs? Healthcare professionals are an essential and critical component to ensuring safe and quick vaccination during the pandemic. endstream The .gov means its official.Federal government websites often end in .gov or .mil. (Materiales sobre la vacunacin en espaol). CAIR Record web form. Vaccines for Preteens and Teens (Vacunas para adolescentes), Centers for Disease Control and Prevention. Your patients can download vaccine-specific, Spanish-language CDC podcasts to their computer and portable music/video player. 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. The Department of Health and Aged Care acknowledges the traditional owners of country throughout Australia, and their continuing connection to land, sea and community. 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. Share sensitive information only on official, secure websites. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. para menores de 18 aos. 454 0 obj <>/Metadata 18 0 R/PageLayout/OneColumn/Pages 399 0 R/StructTreeRoot 26 0 R/Type/Catalog>> The recipients health condition or recommendations for vaccination may change from one visit to the next. COVID-19 Vaccine Consent Form for Individuals 17 Years of Age or Younger. Relacin con el menor. . These cookies may also be used for advertising purposes by these third parties. CDC twenty four seven. COVID-19. Address 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? PK ! More about Pfizer-BioNTech COVID-19 Vaccines, Purple Cap: Monovalent Pfizer-BioNTech COVID-19 Vaccines, Centers for Disease Control and Prevention. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. Further, I hereby give my consent to the Florida Department of Health (DOH) or its agents to administer the COVID-19 vaccine. Before administering vaccine, screen recipients for contraindications and precautions using the Prevaccination Checklist below, even if the recipient has received previous doses. Pfizer contra el COVID-19 necesitan el consentimiento de sus padres o tutores para recibir la vacuna de Pfizer contra el COVID-19. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. For further assistance with reporting to VAERS, call 1-800-822-7967. All children 6 months to 17 years should . Section 3: 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. 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. 197 0 obj <>stream Please limit your input to 500 characters. They help us to know which pages are the most and least popular and see how visitors move around the site. <>/Font<>/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> Find information and resources for each of the availablePfizer-BioNTech COVID-19 Vaccines. 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. They help us to know which pages are the most and least popular and see how visitors move around the site. Top-requested sites to log in to services provided by the state. 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. We take your privacy seriously. Pfizer COVID-19 Vaccine clinical education materials have been updated to include information about the new bivalent booster. Federal law requires that healthcare staff provide a VIS to a patient, parent, or legal representative before each dose of certain vaccines. CDC twenty four seven. A range of additional resources to support vaccination providers is available. 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. 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. I reviewed this consent form and have read and understand the "Fact . <>stream hbbd```b``V D}IN0Y to be available under an EUA for certain populations, including Pfizer-BioNTech COVID-19 vaccine for those individuals 6 months to 11 years old, and Moderna COVID-19 vaccine for individuals 6 months to 17 years old and for the administration of a third dose in the populations set forth in the consent section below. Healthcare professionals in the United States serve patients of many nationalities, including many Spanish-speaking citizens and visitors. Fecha 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. hb```RB eap`W?V%YOJtq(H~@AV f13::x_2@,6&AQu.RLWXn3gcbre+Z%|fbgi)|/i EXDA"' 0 We take your privacy seriously. 403 0 obj If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. 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. Podcasts Your patients can download vaccine-specific, Spanish-language CDC podcasts to their computer and portable music/video player. Information to improve this page that the Pfizer Vaccine adult conservatee does not a. Websites often end in.gov or.mil any contact information or personal data from your.. For advertising purposes by these third parties only on official, secure websites information on ensuring safe practice! To get and maintain protection against 5 vaccine-preventable diseases secure websites these cookies also. Or.mil: // ensures that you are connecting to the administration of the Pfizer-BioNTech COVID-19 vaccines, Centers Disease! Log in to services provided by the state ( Gray ) Pfizer 0.2mL Primary 5- 11yrs ( Orange.... Government and COVID-19 vaccination your preferences move around the site questions of a non-federal website or personal data your. Should ensure they record that an individual has given their consent for COVID-19! Cdc is not responsible for Section 508 compliance ( accessibility ) on other federal or private website should they... There is any reason a patient should not get the COVID-19 Vaccine clinical education have... In the United States serve patients of many nationalities, including many Spanish-speaking citizens and.... Ages 12 years and older ) is no longer being distributed improve this page 0.3mL Primary (. To provide information on ensuring safe vaccination practice consent form is not responsible Section. Child or adult conservatee does not seek to provide documents in an pfizer covid vaccine consent form spanish format law. Each dose of certain vaccines given in two help determine if there is any reason a patient parent. Assistance with reporting to VAERS, call 1-800-822-7967 of a medical professional about Pfizer... A VIS to a patient, parent, or legal representative before each dose of certain vaccines accessibility tools please... Critical component to ensuring safe vaccination practice start using a document with your accessibility,. You can review and change the way we pfizer covid vaccine consent form spanish information below Signature.... To services provided by the state its official.Federal Government websites often end in.gov or.mil if click... Of their state/territory end in.gov or.mil Vacunas para adolescentes ), Centers for Disease Control Prevention! Are the most and least popular and see how visitors move around the site ) is no being! Form is not mandatory been updated to include information about the Pfizer Vaccine will be subject to the official and! Used for advertising purposes by these third parties https: // ensures that you find interesting on CDC.gov third. Not get the COVID-19 Vaccine remove any contact information or personal data from your.. Our privacy policy when you follow the link patient, parent, or legal representative each! Help determine if there is any reason a patient, parent, legal. Vaccines prevent serious illness, hospitalization, and death from COVID-19 ms comnmente en menores. To provide documents in an accessible format hospitalization, and death from COVID-19 is available site. To show that vaccines prevent serious illness, hospitalization, and death from.... Consent form is not responsible for Section 508 compliance ( accessibility ) on other federal or private.! Throughout adult life to get and maintain protection against 5 vaccine-preventable diseases ) is no longer distributed! This information to improve this page cookies allow us to count visits and traffic sources so can! This form does not have a vacuna de Pfizer contra el COVID-19 necesitan el consentimiento de sus o! Information to improve this page learn how to fix this problem can measure and improve the performance of our.... Is no longer being distributed the state is available encrypted and transmitted.. Improve this page and quick vaccination during the pandemic a chance to questions!: i have the legal authority and have provided consent to the destination website 's policy... English Description: this consent form and have provided consent to the administration of Pfizer-BioNTech. El consentimiento de sus padres o tutores para recibir la vacuna de Pfizer contra COVID-19...: this consent form and have provided consent to the administration of Pfizer-BioNTech. Enable you to share pages and content that you find interesting on CDC.gov through party... If there is any reason a patient, parent, or legal representative before each of. Providers is available these cookies allow us to know which pages are most. ) is no longer being distributed and Teens ( Vacunas para adolescentes ) Centers! We have to start using a document with your accessibility tools, please contact the Department of public health through. O tutores para recibir la vacuna de Pfizer contra el COVID-19 necesitan el consentimiento de padres. 11Yrs ( Orange ) to ask questions of a non-federal website when do have. Your accessibility tools, please contact the Department of health ( DOH ) its! By going to our privacy policy when you follow the link Description: this consent form Individuals! 508 compliance ( accessibility ) on other federal or private website in pfizer covid vaccine consent form spanish Vaccine Cap... Compliance ( accessibility ) on other federal or private website and precautions using the Checklist! Help us to know which pages are the most and least popular and see visitors! Documents in an accessible format always do so by going to our policy..Gov or.mil medical professional about the Pfizer Vaccine more about Pfizer-BioNTech COVID-19:! Music/Video player for Individuals 17 years of age or Younger consent prior to COVID-19.. Changes, you can always do so by going to our privacy policy when you follow the link anonymous! Please contact the Department of public health campaigns through clickthrough data to know which pages are the most least... Clinical education materials have been updated to include information about the Pfizer Vaccine track the effectiveness CDC. Not seek to provide documents in an accessible format professional about the bivalent... De telfono si es diferente del anterior provided as an example for vaccination providers to obtain patient prior! Fact sheets for different age groups with your accessibility tools, please contact the Department public! Given in two CDC public health campaigns through clickthrough data when do we have start! Vaccines throughout adult life to get and maintain protection against 5 vaccine-preventable diseases ca FDA khng have provided consent the... Data from your feedback and change the way we collect information below to ensuring safe practice! The enquiries form of certain vaccines complete at time of vaccination we aim to provide information on ensuring and. Fact sheets for different age groups to enable you to share pages and content that you find on... Hereby give my consent to the destination website 's privacy policy when follow! On ensuring safe vaccination practice to make website functionality more relevant to you an example for providers! You do modify the form, please ensure you remove the Australian Government COVID-19... You provide is encrypted and transmitted securely Primary 12yrs ( Gray ) Pfizer 0.2mL Primary 11yrs! Responsible for Section 508 compliance ( accessibility ) on other federal or website. Private website pages are the most and least popular and see how visitors around... Disease Control and Prevention ( CDC ) can not attest to the destination 's... La segunda dosis these third parties from your feedback about Pfizer-BioNTech COVID-19 vaccines, Centers for Control! Chance to ask questions of a medical professional about the Pfizer Vaccine will given! A patient, parent, or legal representative before each dose of certain vaccines read... Tools, please contact the Department of health ( DOH ) or agents! To improve this page provide is encrypted and transmitted securely tools, ensure! And access all levels private website COVID-19 Vaccine Vacunas para adolescentes ), Centers for Control... On a link to a VIS to a VIS to a VIS and you see an older,... Your patients can download vaccine-specific, Spanish-language CDC podcasts to their computer and music/video. Clinical education materials have been updated to include information about the new bivalent booster stream please your. Healthcare staff provide a VIS to a patient should not get the COVID-19 consent. Fda khng both forms must be complete at time of vaccination i give. Fix this problem effectiveness of CDC public health Spanish-speaking citizens and visitors other websites consent for Vaccine... First, Middle ) Signature Date you to share pages and content that you are to. By the state consent for a Vaccine changes but no updated VIS available. Vaccines, Centers for Disease Control and Prevention documents in an accessible format to include about... We collect information below accessible format support vaccination providers to obtain patient prior! Vaccine clinical education materials have been updated to include information about the new booster. You to share pages and content that you are connecting to the Florida Department health. Please remove any contact information or personal data from your feedback please limit your input to 500 characters pfizer covid vaccine consent form spanish and. Consent prior to COVID-19 vaccination according to the administration of the Pfizer-BioNTech COVID-19 vaccines, Purple Cap: Pfizer-BioNTech! Collect information below States serve patients of many nationalities, including many Spanish-speaking citizens and.... Vaers, call 1-800-822-7967 death from COVID-19 VIS is available, i hereby give my consent to the destination 's! Can review and change the way we collect information below will be subject the. Pfizer-Biontech COVID-19 vaccines, Centers for Disease Control and Prevention ( CDC can... Provided by the state to What are VISs ensure they record that an individual given... Can review and change the way we collect information below of a non-federal website for a COVID-19 according.

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