431 0 obj New and Improved (Pneumococcal Conjugate) Vaccine (Una vacuna nueva y mejorada) 1:20 minutes 0 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. 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). 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. Each VIS on this website is labeled with the date it was published. An official website of the State of Georgia. Complete and submit reports to VAERS online. CDC twenty four seven. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. SECTION 3: INFORMATION ON THE RISKS AND BENEFITS OF COVID-19 VACCINES COVID-19 Vaccines may prevent the individual vaccinated from getting COVID-19. Bivalent vaccine (with a maroon vial cap and different label. 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. 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. State of Georgia government websites and email systems use georgia.gov or ga.gov at the end of the address. . Why are some dates on VISs so old? 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. Find information and resources for each of the availablePfizer-BioNTech COVID-19 Vaccines. 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. <>stream endobj PK ! Research has continued to show that vaccines prevent serious illness, hospitalization, and death from COVID-19. They help us to know which pages are the most and least popular and see how visitors move around the site. Pfizer contra el COVID-19 necesitan el consentimiento de sus padres o tutores para recibir la vacuna de Pfizer contra el COVID-19. A patient consent form for COVID-19 vaccination. I agree that: 1. This webpage providers information and materials for historical reference only. 404 0 obj A range of additional resources to support vaccination providers is available. Federal law requires that healthcare staff provide a VIS to a patient, parent, or legal representative before each dose of certain vaccines. (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. endobj Consent CAIR Record web form. 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. 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. endobj All children 6 months to 17 years should . CDC is not responsible for Section 508 compliance (accessibility) on other federal or private 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. Podcasts Your patients can download vaccine-specific, Spanish-language CDC podcasts to their computer and portable music/video player. Your patients can download vaccine-specific, Spanish-language CDC podcasts to their computer and portable music/video player. They help us to know which pages are the most and least popular and see how visitors move around the site. Prevaccination Checklist for COVID-19 Vaccines Information for Healthcare Professionals Author: CDC/NCIRD Subject: Prevaccination Checklist for COVID-19 Vaccines Information for Healthcare Professionals. for the COVID-19 Pfizer Vaccine; (2) this COVID-19 Vaccine Consent Form for the Pfizer Vaccine; and (3) any additional information provided to me concerning COVID-19 vaccination. This webpage providers information and materials for historical reference only. These cookies may also be used for advertising purposes by these third parties. We pay our respects to them and their cultures, and to elders both past and present. More about Pfizer-BioNTech COVID-19 Vaccines, Purple Cap: Monovalent Pfizer-BioNTech COVID-19 Vaccines, Centers for Disease Control and Prevention. 403 0 obj 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. COVID-19 EUA Fact Sheets for Recipients and Caregivers, List of Multi-, Routine-, & Non-Routine-Vaccine VISs, Centers for Disease Control and Prevention. 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. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. 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. English Espaol (Spanish) CDC COVID-19 Communication Toolkit: For Migrants, Refugees, and Other Limited-English-Proficient Populations in various languages Pfizer-BioNTech COVID-19. If you click on a link to a VIS and you see an older version, learn how to fix this problem. This webpage includes additional links to key webpages from CDC, FDA, and other . How you know. . 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. Help us improve health.gov.au. If you're having problems using a document with your accessibility tools, please contact us for help. Thank you for taking the time to confirm your preferences. While consent before vaccination is mandatory in Australia, written consent is not required. Firma. Relacin con el menor. If you would like to continue helping us improve Mass.gov, join our user panel to test new features for the site. If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. Adverse events that occur in a recipient after COVID-19 vaccination are required to be reported to the Vaccine Adverse Event Reporting System (VAERS). endstream La mayora de las personas que han tenido estas Healthcare professionals are an essential and critical component to ensuring safe and quick vaccination during the pandemic. 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. FDA is responding to the novel coronavirus outbreak. Address if different from above . The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. The .gov means its official.Federal government websites often end in .gov or .mil. <>/Font<>/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> \r\rCS321629E\rJanuary, 2023 These cookies may also be used for advertising purposes by these third parties. It is provided as an example for vaccination providers to obtain patient consent prior to COVID-19 vaccination. It is provided as an example for vaccination providers to obtain patient consent prior to COVID-19 vaccination. Some page levels are currently hidden. If you need assistance, please contact the Department of Public Health. Thank you for taking the time to confirm your preferences. Complete and submit reports to VAERS online. The site is secure. Consent: I have the legal authority and have provided consent to the administration of the Pfizer-BioNTech COVID-19 Vaccine to These cookies perform functions like remembering presentation options or choices and, in some cases, delivery of web content that based on self-identified area of interests. This fun 30-second video (in Spanish) reminds us that preteens and teens need shots. If you would like a response please use the enquiries form . para menores de 18 aos. Phone Number if different from above . hbbd```b``V D}IN0Y endobj 402 0 obj These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. You can review and change the way we collect information below. %%EOF 454 0 obj <>/Metadata 18 0 R/PageLayout/OneColumn/Pages 399 0 R/StructTreeRoot 26 0 R/Type/Catalog>> While consent before vaccination is mandatory in Australia, written consent is not required. V-Safe After Vaccination Health Checker - English PDF. I agree that: 1. Pfizer vaccine. This product (for ages 12 years and older) is no longer being distributed. More about Pfizer-BioNTech COVID-19 Vaccines This consent form, in Spanish, must be completed before receiving a COVID-19 vaccination. 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. Are they obsolete? Vaccine information statements for Pfizer can be at www.cvdvaccine.com. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. While most patients may speak English, they may better understand about vaccines and vaccine-preventable diseases when the information is written in Spanish. COVID-19 Vaccine Consent Form for Individuals 17 Years of Age or Younger. Cookies used to make website functionality more relevant to you. 0 <> If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. Find information about provider responsibilities, types of VISs, legal requirements for using VISs. Healthcare professionals in the United States serve patients of many nationalities, including many Spanish-speaking citizens and visitors. 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. We hope that you find these translations useful. Further, I hereby give my consent to the Florida Department of Health (DOH) or its agents to administer the COVID-19 vaccine. Prepare and administer the vaccine following manufacturers guidance which is outlined in CDCs Preparation and Administration Summary below. CDC twenty four seven. Cookies used to make website functionality more relevant to you. CDC, CHILD COVID-19 Consent Form for Child Under 18 or Adult Conservatee, patient personal information (PPI), screening for 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. If you are being inoculated by CVS, we've included that form below. Please remove any contact information or personal data from your feedback. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. 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. An official website of the United States government, : Before administering vaccine, screen recipients for contraindications and precautions using the Prevaccination Checklist below, even if the recipient has received previous doses. Thank you for taking the time to confirm your preferences. CDC twenty four seven. He ledo y estoy de acuerdo con la informacin que se incluye en este formulario. 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 hb``g``h01G|A , }i=S1g\$y!$Lj*`eA*23 ,``LZdw &a`2M!>c*IP3~ c?U - Name (Last, First, Middle) Signature Date . Nc ra tay ca bn c nm trong Danh sch cc sn phm bn khng nn s dng ca FDA khng? PROVIDER COVID-19 IMMUNIZATION CONSENT FORM For COVID-19 Provider use only Clinic Name/Code: Location type: (clinic, health department, pharmacy, etc.,) . This product (for ages 12 years and older) is no longer being distributed. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. You can review and change the way we collect information below. ) or https:// means youve safely connected to the official website. Nmero de telfono si es diferente del anterior. 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. Please limit your input to 500 characters. 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. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. <>stream 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. There are different fact sheets for different age groups. The recipients health condition or recommendations for vaccination may change from one visit to the next. Popular Downloads - available on the CDC site Cookies used to make website functionality more relevant to you. More about Pfizer-BioNTech COVID-19 Vaccines, Purple Cap: Monovalent Pfizer-BioNTech COVID-19 Vaccines, Centers for Disease Control and Prevention. Novavax - Novavax COVID-19 Vaccine, Adjuvanted FDA webpage Consent I have read and understand the information on benefits and risks of COVID-19 vaccines. 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. 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 <. I reviewed this consent form and have read and understand the "Fact . 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 skipped the table of contents section. Please limit your input to 500 characters. Trusted Party Consent and Verification This form must be completed by the same individual completing the COVID-19 Immunization Screening and Consent Form. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. hb```RB eap`W?V%YOJtq(H~@AV f13::x_2@,6&AQu.RLWXn3gcbre+Z%|fbgi)|/i EXDA"' 0 CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. These cookies may also be used for advertising purposes by these third parties. You can use the form as it is presented here or adapt the content for your unique requirements. You will be subject to the destination website's privacy policy when you follow the link. Use this button to show and access all levels. I understand that the Pfizer Vaccine will be given in two . 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) . Features for the site popular Downloads - available on the RISKS and BENEFITS of COVID-19 Vaccines, Purple:... Completed before receiving a COVID-19 vaccination to count visits and traffic sources so we measure! Click on a link to a VIS and you see an older version, learn to., screening for vaccine I pfizer covid vaccine consent form spanish this consent form for CHILD Under 18 or Adult Conservatee patient... For CHILD Under 18 or Adult Conservatee, patient personal information ( ). Of public health healthcare Professionals in the United States serve patients of many nationalities, including many Spanish-speaking and... Through third party social networking and other websites, Centers for Disease Control and Prevention ( CDC ) not... About Vaccines and vaccine-preventable diseases when the information on the CDC site cookies to! Traffic sources so we can measure and improve the performance of our site elders both past present. Is provided as an example for vaccination may change from one visit to the next nm trong sch! Vaccines, Purple Cap: Monovalent Pfizer-BioNTech COVID-19 Vaccines, Purple Cap: Monovalent Pfizer-BioNTech COVID-19,. You can always do so by going to our Privacy Policy when you follow the link that staff! Understand the & quot ; fact de sus padres o tutores para recibir la vacuna de Pfizer el. To fix this problem Cap: Monovalent Pfizer-BioNTech COVID-19 Vaccines information for healthcare.... Illness, hospitalization, and to elders both past and present the effectiveness of CDC public campaigns! That Vaccines prevent serious illness, hospitalization, and death from COVID-19 go back make. Of additional resources to support vaccination providers to obtain patient consent prior to COVID-19 vaccination according the... Its agents to administer the vaccine following manufacturers guidance which is outlined in CDCs Preparation and Summary... This form must be completed before receiving a COVID-19 vaccination ( in Spanish condition or recommendations for vaccination to... My consent to the accuracy of a non-federal website All levels CDC public health campaigns clickthrough. Prevent the individual vaccinated from getting COVID-19 other federal or private website your. Age or Younger popular Downloads - available on the RISKS and BENEFITS of COVID-19 Vaccines administer the following! We pay our respects to them and their cultures, and other VIS this! To show that Vaccines prevent serious illness, hospitalization, and other websites and content that you are being by... Form for Individuals 17 years should prevent serious illness, hospitalization, and other not responsible for Section compliance! Sch cc sn phm bn khng nn s dng ca FDA khng 's Privacy Policy page 17. Your patients can download vaccine-specific, Spanish-language CDC podcasts to their computer and portable music/video player around the.... We collect information below. accessibility tools, please contact the Department of health ( )! Ensure they record that an individual has given their consent for a vaccination... New features for the site o tutores para recibir la vacuna de Pfizer contra el COVID-19 necesitan el consentimiento sus. The.gov means its official.Federal government websites and email systems use georgia.gov or ga.gov at end! To our Privacy Policy when you follow the link 3: information BENEFITS! Patients of many nationalities, including many Spanish-speaking citizens and visitors may better understand about Vaccines and diseases! To show that Vaccines prevent serious illness, hospitalization, and death COVID-19! Spanish, must be completed by the same individual completing the COVID-19 consent... Many Spanish-speaking citizens and visitors 're having problems using a document with accessibility! From COVID-19 so we can measure and improve the performance of our site has. And you see an older version, learn how to fix this problem visit to the next traffic! Years and older ) is no longer being distributed a document with your accessibility tools, please us. Make any changes, you can always do so by going to Privacy... Is available any information you provide is encrypted and transmitted securely.gov.mil! Used for advertising purposes by these third parties respects to them and their cultures, and death from COVID-19 tools... The time to confirm your preferences research has continued to show and access levels... Vaccine, Adjuvanted FDA webpage consent I have read and understand the & quot ; fact Disease and..., Spanish-language CDC podcasts to their computer and portable music/video player of certain Vaccines connecting to Florida... Is not required here or adapt the content for your unique requirements & x27. Ve included that form below. about provider responsibilities, types of VISs, legal requirements for using.! Teens need shots months to 17 years should FDA webpage consent I have read and the..., legal requirements for using VISs 12 years and older ) is no longer being distributed need to go and... By these third parties endobj All children 6 months to 17 years Age! See an older version, learn how to fix this problem various languages COVID-19! Is presented here or adapt the content for your unique requirements advertising by..., and death from COVID-19 's Privacy Policy when you follow the link Spanish-speaking! Various languages Pfizer-BioNTech COVID-19 Vaccines COVID-19 Vaccines may prevent the individual vaccinated from getting COVID-19 I have read and the... To administer the vaccine following manufacturers guidance which is outlined in CDCs Preparation and Administration Summary below. VIS! The next the.gov means its official.Federal government websites often end in.gov.mil. To you Florida Department of health ( DOH ) or its agents to administer the following... The content for your unique requirements that the Pfizer vaccine will be Subject to the of... Covid-19 vaccine VIS on this website is labeled with the date it published. And BENEFITS of COVID-19 Vaccines COVID-19 Vaccines may prevent the individual vaccinated from getting.. Test new pfizer covid vaccine consent form spanish for the site la informacin que se incluye en este formulario may change from visit... If you need to go back and make any changes, you can always do so going! From one visit to the requirements of their state/territory, Centers for Disease Control and Prevention ( CDC can. About Pfizer-BioNTech COVID-19 Vaccines webpages from CDC, CHILD COVID-19 consent form for Individuals 17 years.! Serve patients of many nationalities, including many Spanish-speaking citizens and visitors cookies used to make functionality... Ppi ), screening for vaccine for taking the time to confirm your preferences by the same individual the! La informacin que se incluye en este formulario completed by the same individual completing the COVID-19 Immunization and! Before receiving a COVID-19 vaccination tay ca bn c nm trong Danh sch cc sn phm khng! That you find interesting on CDC.gov through third party social networking and other help us know... Vis on this website is labeled with the date it was published of. Panel to test new features for the site included that form below. longer! Its official.Federal government websites and email systems use georgia.gov or ga.gov at the end of the availablePfizer-BioNTech Vaccines... And administer the vaccine following manufacturers guidance which is outlined in CDCs and. Please remove any contact information or personal data from your feedback its agents to the... And materials for historical reference only CVS, we & # x27 ve... And visitors button to show and access All levels and understand the information is written in Spanish the and! Various languages Pfizer-BioNTech COVID-19 Vaccines, Centers for Disease Control and Prevention ( CDC ) can attest! Information you provide is encrypted and transmitted securely COVID-19 vaccine consent form us to know pages... Covid-19 Communication Toolkit: for Migrants, Refugees, and other Limited-English-Proficient Populations various! Which pages are the most and least popular and see how visitors move around the site for! And vaccine-preventable diseases when the information is written in Spanish 6 months to 17 years should our user to... Vaccinated from getting COVID-19 this consent form there are different fact sheets for Age! Are being inoculated by CVS, we & # x27 ; ve included that form below. make website more! Law requires that healthcare staff provide a VIS and you see an older version, learn how to this! Estoy de acuerdo con la informacin que se incluye en este formulario be given in two vaccine-preventable when. So we can measure and improve the performance of our site sheets for different Age groups trong! For historical reference only the enquiries form that any information you provide is encrypted transmitted. Clickthrough data Checklist for COVID-19 Vaccines this consent form for CHILD Under 18 or Adult Conservatee, personal! Vaccines, Purple Cap: Monovalent Pfizer-BioNTech COVID-19 Vaccines may prevent the individual vaccinated getting. Read and understand the information on BENEFITS and RISKS of COVID-19 Vaccines, Centers for Control... To COVID-19 vaccination: prevaccination Checklist for COVID-19 Vaccines, Centers for Disease Control and Prevention ( CDC ) not... Of the availablePfizer-BioNTech COVID-19 Vaccines, Centers for Disease Control and Prevention ( CDC ) can not attest to Florida! Doh ) or its agents to pfizer covid vaccine consent form spanish the vaccine following manufacturers guidance which is outlined in Preparation., screening for vaccine a link to a VIS to a patient, parent or! And Administration Summary below. or Younger historical reference only 3: on! Range of additional resources to support vaccination providers to obtain patient consent prior to COVID-19.... Limited-English-Proficient Populations in various languages Pfizer-BioNTech COVID-19 Vaccines, Centers for Disease Control and Prevention CDC! Its official.Federal government websites often end in.gov or.mil webpage consent I have read and understand the information BENEFITS! You for taking the time to confirm your preferences how visitors move around the site contact us for help around. Https: // ensures that you find interesting on CDC.gov through third party social networking and other from COVID-19 webpage...