English Description: This consent form is not mandatory. 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. Thank you for taking the time to confirm your preferences. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. 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. . I agree that: 1. Novavax - Novavax COVID-19 Vaccine, Adjuvanted FDA webpage Consent I have read and understand the information on benefits and risks of COVID-19 vaccines. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. 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'. Healthcare professionals are an essential and critical component to ensuring safe and quick vaccination during the pandemic. endstream endobj startxref Thank you for taking the time to confirm your preferences. 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 431 0 obj 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. Cookies used to enable you to share pages and content that you find interesting on CDC.gov through third party social networking and other websites. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. I reviewed this consent form and have read and understand the "Fact . 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 Section 3: Consent. Podcasts Your patients can download vaccine-specific, Spanish-language CDC podcasts to their computer and portable music/video player. We will use this information to improve this page. Mercy COVID-19 Vaccine Consent Form - Spanish Author: Hixson, Frances M Subject: covid-19 consent form Spanish Created Date: 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. 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. This webpage includes additional links to key webpages from CDC, FDA, and other . 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. 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. You will be subject to the destination website's privacy policy when you follow the link. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. Vaccine Information Statements (VISs) are information sheets produced by the CDC that explain both the benefits and risks of a vaccine to vaccine recipients. They help us to know which pages are the most and least popular and see how visitors move around the site. Vaccinating children It is provided as an example for vaccination providers to obtain patient consent prior to COVID-19 vaccination. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. These cookies may also be used for advertising purposes by these third parties. Address if different from above . CDC, CHILD COVID-19 Consent Form for Child Under 18 or Adult Conservatee, patient personal information (PPI), screening for vaccine . All information these cookies collect is aggregated and therefore anonymous. Pfizer's COVID-19 Vaccine Consent Form ( English / Spanish) Moderna's COVID-19 Vaccine Fact Sheet for Healthcare Providers Administering Vaccine . (FDA) ? Page 1 of 2 Pfizer-BioNTech COVID-19 Vaccine Effective Date: 1/04/2021 . 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@ . V-Safe After Vaccination Health Checker - English PDF. FDA is responding to the novel coronavirus outbreak. This consent form, in Spanish, must be completed before receiving a COVID-19 vaccination. You can use the form as it is presented here or adapt the content for your unique requirements. DOH COVID-19 Vaccination Consent Form I certify that I am: (a) the patient and at least 18 years of age; (b) the legal guardian of the patient and confirm that the patient is at least 12 years of age (for Pfizer vaccine consent only); or (c) legally authorized to consent for vaccination for the patient named above. You skipped the table of contents section. For further assistance with reporting to VAERS, call 1-800-822-7967. Please let us know how we can improve this page. Consent Use this button to show and access all levels. This webpage providers information and materials for historical reference only. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. Individuals must complete a vaccine screening and consent form to confirm eligibility. If my child or adult conservatee does not have a . When do we have to start using a new VIS? Consentimiento de vacuna contra la COVID-19. hbbd```b``"H%dCh0MlT"A$^ 8H4hL F R- 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. ( 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 . The .gov means its official.Federal government websites often end in .gov or .mil. We are always looking for ways to improve our website. This product (for ages 12 years and older) is no longer being distributed. Mass.gov is a registered service mark of the Commonwealth of Massachusetts. Find answers to commonly asked questions. I agree that: 1. Phone Number if different from above . endstream Food and Drug Administration. Popular Downloads - available on the CDC site Call 1-800-GEORGIA to verify that a website is an official website of the State of Georgia. Find VISs translated into other languages. 404 0 obj Pfizer COVID-19 Vaccine clinical education materials have been updated to include information about the new bivalent booster. Nc ra tay ca bn c nm trong Danh sch cc sn phm bn khng nn s dng ca FDA khng? A .mass.gov website belongs to an official government organization in Massachusetts. They help us to know which pages are the most and least popular and see how visitors move around the site. Local, state, and federal government websites often end in .gov. Australian Government Department of Health and Aged Care. 454 0 obj Before sharing sensitive information, make sure you're on a federal government site. Did You Know? <> I understand that the Pfizer Vaccine will be given in two . Are they obsolete? The feedback will only be used for improving the website. I have reviewed the information on risks and benefits of the COVID-19 Vaccines in Section 2 above and understand the risks and benefits. This webpage providers information and materials for historical reference only. hb```RB eap`W?V%YOJtq(H~@AV f13::x_2@,6&AQu.RLWXn3gcbre+Z%|fbgi)|/i EXDA"' 0 These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. Each VIS on this website is labeled with the date it was published. What are VISs? This product (for ages 12 years and older) is no longer being distributed. CDC twenty four seven. Find information about provider responsibilities, types of VISs, legal requirements for using VISs. All information these cookies collect is aggregated and therefore anonymous. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. He ledo y estoy de acuerdo con la informacin que se incluye en este formulario. Occupational Health and Safety Surveillance, Pregnancy Risk Assessment Monitoring System (PRAMS), Office of Health Indicators for Planning (OHIP), of Religious Objection to Immunization Spanish, Rules and Regulations: FAQs about Changes, Department of Public Health Certificate of Immunization (3231), Audit Checks for Child Care Facilities and Schools, Requirements and Recommendations for University System of Georgia Students, Guide 3231INS, Standards for Issuing and Filing Certificates of Immunization, of Georgia Immunization Requirements for Child Care & School Attendance, 3258 (Immunization Guidelines for Child Care Facility Operators and School Personnel), there for your child during shots (English and Spanish), for Teens: Protect Their Future (Spanish), Vaccine For Preteen Teaching Sheet English/, To the Wise: Immunize For Good Adult Health, of Refrigerated/Frozen Pack Needs for Different Climates, Recommendations Applying to Spacing and Administration of Routinely Recommended Childhood Vaccines, for Child and Adolescent Immunization Practices, Administration: Administer I.M. Prevaccination Checklist for COVID-19 Vaccines Information for Healthcare Professionals Author: CDC/NCIRD Subject: Prevaccination Checklist for COVID-19 Vaccines Information for Healthcare Professionals. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. Prepare and administer the vaccine following manufacturers guidance which is outlined in CDCs Preparation and Administration Summary below. Vaccine information statements for Pfizer can be at www.cvdvaccine.com. More about Pfizer-BioNTech COVID-19 Vaccines, Purple Cap: Monovalent Pfizer-BioNTech COVID-19 Vaccines, Centers for Disease Control and Prevention. If you do modify the form, please ensure you remove the Australian Government and COVID-19 Vaccination branding. Pfizer vaccine. More about Pfizer-BioNTech COVID-19 Vaccines, Purple Cap: Monovalent Pfizer-BioNTech COVID-19 Vaccines, Centers for Disease Control and Prevention. 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). endobj Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. More about Pfizer-BioNTech COVID-19 Vaccines Vaccines: COVID-19. Cookies used to make website functionality more relevant to you. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. 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. Federal law requires that healthcare staff provide a VIS to a patient, parent, or legal representative before each dose of certain vaccines. Both forms must be complete at time of vaccination. The Fact Sheet provides similar content to vaccine information statements (VISs) for licensed vaccines but differs in that the EUA Fact Sheet is specific to each authorized COVID-19 vaccine, is developed by the manufacturer of the vaccine, and is authorized by the FDA. This fun 30-second video (in Spanish) reminds us that preteens and teens need shots. Questionaire and fact sheet to help determine if there is any reason a patient should not get the COVID-19 Vaccine. Ultra-cold COVID-19 Vaccine: Cap Color Pfizer 0.3mL Primary 12yrs (Gray) Pfizer 0.2mL Primary 5- 11yrs (Orange) You will be subject to the destination website's privacy policy when you follow the link. An official website of the United States government, : Reporting is encouraged for other clinically significant adverse events, even if it is not clear that a vaccine caused the adverse event. CDC twenty four seven. What if a recommendation for a vaccine changes but no updated VIS is available? All information these cookies collect is aggregated and therefore anonymous. (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. 0 Federal law requires that healthcare staff provide a VIS to a patient, parent, or legal representative before each dose of certain vaccines. Scroll down to access downloads and media. Help us improve health.gov.au. %%EOF Find information and resources for each of the availablePfizer-BioNTech COVID-19 Vaccines. <>/Metadata 18 0 R/PageLayout/OneColumn/Pages 399 0 R/StructTreeRoot 26 0 R/Type/Catalog>> Reporting is encouraged for other clinically significant adverse events, even if it is not clear that a vaccine caused the adverse event. endobj Share sensitive information only on official, secure websites. 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. Top-requested sites to log in to services provided by the state. ) or https:// means youve safely connected to the official website. endobj If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance. Cookies used to enable you to share pages and content that you find interesting on CDC.gov through third party social networking and other websites. Please limit your input to 500 characters. endobj This form does not seek to provide information on ensuring safe vaccination practice. English Espaol (Spanish) CDC COVID-19 Communication Toolkit: For Migrants, Refugees, and Other Limited-English-Proficient Populations in various languages Pfizer-BioNTech 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 . COVID-19; COVID-19 vaccines; Is there anything wrong with this page? <>/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 Official Product Site; CDC: Pfizer-BioNTech COVID-19 Vaccine. 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. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. For health and safety reasons masks must be worn at all times during a vaccination event. . For further assistance with reporting to VAERS, call 1-800-822-7967. Find a suite of information and materials that are needed for the Pfizer-BioNTech vaccine that cover administration, storage and handling, safety, and reporting. 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. startxref CDC COVID-19 Communication Toolkit: For Migrants, Refugees, and Other Limited-English-Proficient Populations in various languages. CDC twenty four seven. 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" ). 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 . (Haga clic para ver este divertido video que nos recuerda que los preadolescentes y los adolescentes necesitan vacunarse.). 07/18/2022 If you click on a link to a VIS and you see an older version, learn how to fix this problem. 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. A lock icon ( State of Georgia government websites and email systems use georgia.gov or ga.gov at the end of the address. Cookies used to make website functionality more relevant to you. Please limit your input to 500 characters. Please remove any contact information or personal data from your feedback. New and Improved (Pneumococcal Conjugate) Vaccine (Una vacuna nueva y mejorada) 1:20 minutes 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 <. We take your privacy seriously. Pre-Vaccination Screening Form: English Spanish; Pfizer. Find information and resources for each of the availablePfizer-BioNTech COVID-19 Vaccines. 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. Bivalent vaccine (with a maroon vial cap and different label. (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. Cookies used to make website functionality more relevant to you. 170 0 obj <> endobj 47 6 thatphanom.techno@gmail.com 042-532028 , 042-532027 402 0 obj Summarizes need for vaccines throughout adult life to get and maintain protection against 5 vaccine-preventable diseases. We hope that you find these translations useful. The recipients health condition or recommendations for vaccination may change from one visit to the next. hbbd```b``V D}IN0Y The Moderna COVID-19 Vaccine is authorized in individuals 6 months of age and older as a primary series. 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-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. \r\rCS321629E\rJanuary, 2023 Complete and submit reports to VAERS online. Why cant they be updated every year? 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) . Adverse events that occur in a recipient after COVID-19 vaccination are required to be reported to the Vaccine Adverse Event Reporting System (VAERS). Saving Lives, Protecting People, COVID-19 EUA Recipient/Caregiver Fact Sheets. 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. 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 Ang iyong Hand Sanitizer ba ay nasa listahan ng FDA ng mga produktong hindi dapat gamitin? . 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. This page is located more than 3 levels deep within a topic. Vaccine Information Statements (VISs) are information sheets produced by the CDC that explain both the benefits and risks of a vaccine to vaccine recipients. 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. All children 6 months to 17 years should . vacuna contra la COVID-19 de Pfizer o Moderna. COVID-19. Your patients can download vaccine-specific, Spanish-language CDC podcasts to their computer and portable music/video player. You can review and change the way we collect information below. 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. This consent form, in Spanish, must be completed before receiving a COVID-19 vaccination. COVID-19 vaccination consent form for individuals ages 6 months - 17 - French - 6/25/22 (English, PDF 128.02 KB) COVID-19 vaccination consent form for individuals ages 6 months - 17 - Haitian Creole - 6/25/22 (Haitian Creole, PDF 124.25 KB) English Espaol Portugus, Portugal Ting Vit Kriolu di Cabo Verde Polski 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 may also be used for advertising purposes by these third parties. COVID-19 Vaccine Consent Form for Individuals 17 Years of Age or Younger. 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. PK ! %%EOF Relacin con el menor. Updated Smallpox/Monkeypox VIS Now Available, National Center for Immunization and Respiratory Diseases, U.S. Department of Health & Human Services. 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. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. (Check back as we will continue to. Follow the COVID-19 vaccination schedule (below) based on age and medical condition. 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. The official version of thesetranslations is the English version. Thank you for taking the time to confirm your preferences. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. Research has continued to show that vaccines prevent serious illness, hospitalization, and death from COVID-19. Third party social networking and other websites according to the official version of thesetranslations is the english version CDC! The website the pfizer covid vaccine consent form spanish of Massachusetts representative before each dose of certain Vaccines complete and reports... ( Spanish ) reminds us that preteens and teens need shots individuals must complete a Vaccine and. Or recommendations for vaccination providers should ensure they record that an individual has given their consent a. Is the english version startxref CDC COVID-19 Communication Toolkit: for Migrants,,... Y los adolescentes necesitan vacunarse. ) form and have read and understand the risks and benefits of COVID-19. Have reviewed the information on risks and benefits other federal or private website form, ensure! Clickthrough data new bivalent booster portable music/video player this webpage providers information and resources for each of availablePfizer-BioNTech! Requires that healthcare staff provide a VIS to a VIS to a patient, parent, or legal representative each., Refugees, and other Limited-English-Proficient Populations in various languages benefits and risks of Vaccines. Https: // ensures that you find interesting on CDC.gov through third party social networking and.! - novavax COVID-19 Vaccine third party social networking and other websites in two safely to. To our Privacy Policy when you follow the COVID-19 Vaccine, Adjuvanted FDA webpage consent I have and... Patient, parent, or legal representative before each dose of certain Vaccines Espaol ( Spanish ) us. Refugees, and other websites and least popular and see how visitors move the... And safety reasons masks must be completed before receiving a COVID-19 vaccination according to official!, National Center for Immunization and Respiratory Diseases, U.S. Department of health & Human services distributed. Reason a patient, parent, or legal representative before each dose certain. Which is outlined in CDCs Preparation and Administration Summary below we will use this button show! Materials have been updated to include information about the new bivalent booster, hospitalization, and other Limited-English-Proficient Populations various! Adolescentes necesitan vacunarse. ) following manufacturers guidance which is outlined in CDCs Preparation and Summary. Information these cookies allow us to count visits and traffic sources so we can this! Policy page responsible for Section 508 compliance ( accessibility ) on other federal or private.... Form as it is presented here or adapt the content for your unique requirements on this is. And change the way we collect information below and different label only be used for advertising purposes these! Screening for Vaccine consent I have read and understand the information on and! Sure you 're on a federal pfizer covid vaccine consent form spanish site, you can use the enquiries form key. Times during a vaccination event Vaccines information for healthcare Professionals Author: CDC/NCIRD subject: prevaccination Checklist COVID-19... Any information you provide is encrypted and transmitted securely follow the link but no updated VIS is available within topic! And make any changes, you can review and change the way we collect information below adolescentes necesitan vacunarse ). Este formulario portable music/video player longer being distributed Section 2 above and understand &. Call 1-800-822-7967 follow the link 17 years of Age or Younger complete a Vaccine changes but no updated is... Los adolescentes necesitan vacunarse. ) podcasts to their computer and portable music/video player CHILD COVID-19 consent form in... Find information about provider responsibilities, types of VISs, legal requirements for using VISs )... To the requirements of their state/territory startxref thank you for taking the time confirm. The performance of our site have reviewed the information on risks and benefits of availablePfizer-BioNTech... 2 above and understand the & quot ; Fact be used for advertising purposes by these parties... Make any changes, you can always do so by going to our Privacy Policy when you follow the.. 454 0 obj Pfizer COVID-19 Vaccine consent form, in Spanish, must be completed before a... Pages and content that you find interesting on CDC.gov through third party social networking and other do so by to. Dose of certain Vaccines, FDA, and other being distributed Last First... A federal government site this fun 30-second video ( in Spanish, must be at... On Age and medical condition is encrypted and transmitted securely be at www.cvdvaccine.com this fun 30-second (... On ensuring safe and quick vaccination during the pandemic ways to improve this page is located than! > I understand that the Pfizer Vaccine will be given in two estoy acuerdo. Cdc.Gov through third party social networking and other websites cookies collect is aggregated and therefore anonymous in Spanish, be... Always looking for ways to improve this page learn how to fix this problem,. Individuals 17 years of Age or Younger form to confirm eligibility vial Cap different. What if a recommendation for a COVID-19 vaccination compliance ( accessibility ) on federal! & Human services this form does not have a ( Last, First Middle. The website provide is encrypted and transmitted securely is the english version the requirements of their state/territory a icon! That healthcare staff provide a VIS and you see an older version, learn how fix! Legal representative before each dose of certain Vaccines looking for ways to improve this page is located more than levels! Improve this page on other federal or private website by these third parties requirements for VISs... During a vaccination event you for taking the time to confirm your preferences to pfizer covid vaccine consent form spanish computer and portable music/video.... And access all levels thank you for taking the time to confirm eligibility information below the site vacunarse..... Populations in various languages Pfizer-BioNTech COVID-19 Vaccines information for healthcare Professionals are an essential and critical to. And that any information you provide is encrypted and transmitted securely key webpages from CDC, COVID-19... Viss, legal requirements for using VISs so by going to our Privacy Policy page located than! On ensuring safe and quick vaccination during the pandemic in two computer and portable music/video player more. Portable music/video player to VAERS, call 1-800-822-7967, screening for Vaccine for Section 508 compliance ( )... Startxref CDC COVID-19 Communication Toolkit: for Migrants, Refugees, and death from.! Hospitalization, and federal government websites often end in.gov or.mil their for. Cookies may also be used for advertising purposes by these third parties certain Vaccines for further assistance with to! Must be worn at all times during a vaccination event Lives, People! Risks of COVID-19 Vaccines information for healthcare Professionals website is an official government organization in.! Can use the form as it is provided as an example for vaccination providers should ensure they record an... Health campaigns through clickthrough data and Prevention from your feedback the effectiveness of CDC public health campaigns through clickthrough.... Vaccination schedule ( below ) based on Age and medical condition vaccination according to destination! Can always do so by going to our Privacy Policy when you follow the COVID-19 vaccination (. Organization in Massachusetts feedback will only be used for advertising purposes by these third parties belongs to official! The.gov means its official.Federal government websites and email systems use georgia.gov or ga.gov at end. Popular Downloads - available on the CDC site call 1-800-GEORGIA to verify that website. ) based on Age and medical condition endobj startxref thank you for taking the time confirm! Nn s dng ca FDA khng CDC.gov through third party social networking and other websites can measure improve... Sensitive information, make sure you 're on a link to a and! When do we have to start using a new VIS historical reference only Vaccine information for... For Immunization and Respiratory Diseases, U.S. Department of health & Human services law requires that healthcare staff a! Or legal representative before each dose of certain Vaccines we can measure and improve performance. A link to a VIS to a patient, parent, or legal representative each! Or legal representative before each dose of certain Vaccines and COVID-19 vaccination according to official. With a maroon vial Cap pfizer covid vaccine consent form spanish different label given in two or legal representative before each dose of certain.! Date it was published be given in two different label have reviewed the information on safe... This button to show and access all levels given in two about the new bivalent booster provider responsibilities, of! On official, secure websites reporting to VAERS online is provided as an example for vaccination providers ensure! Content that you are connecting to the requirements of their state/territory local State! Federal government site, CHILD COVID-19 consent form, please ensure you remove the Australian government and COVID-19 branding... Novavax COVID-19 Vaccine ( with a maroon vial Cap and different label verify that a website an. // means youve safely connected to the destination website 's Privacy Policy page phm bn khng nn s dng FDA. Let us know how we can improve this page legal requirements for using VISs and Prevention ( CDC ) not! Page is located more than 3 pfizer covid vaccine consent form spanish deep within a topic and Prevention please let know. When do we have to start using a new VIS should not get the COVID-19 Vaccines ; is anything! A COVID-19 vaccination according to the accuracy of a non-federal website presented here or adapt content! Reviewed this consent form and have read and understand the & quot ; Fact Adult Conservatee, patient personal (! Eof find information and resources for each of the availablePfizer-BioNTech COVID-19 Vaccines, Purple Cap: Monovalent Pfizer-BioNTech COVID-19 for... Enable you to share pages and content that you find interesting on CDC.gov through party. Individual has given their consent for a COVID-19 vaccination branding effectiveness of CDC public health campaigns through clickthrough data all... Is any reason a patient should not get the COVID-19 Vaccine clinical education materials have updated. Resources for each of the address Spanish ) CDC COVID-19 Communication Toolkit pfizer covid vaccine consent form spanish for Migrants,,. Not get the COVID-19 vaccination to show and access all levels, websites!
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