Name (Last, First, Middle) Signature Date . (Intramuscular) Injections/Subcutaneous Injections, of Recommendations for Adult Immunization, of Recommendations for Childhood and Adolescent Immunization, and minimum ages and intervals between vaccine doses of routinely recommended vaccines, Facebook page for Georgia Department of Public Health, Twitter page for Georgia Department of Public Health, Linkedin page for Georgia Department of Public Health, Instagram page for Georgia Department of Public Health, YouTube page for Georgia Department of Public Health, Storage and Handling of COVID-19 Vaccines, Pfizer-BioNTech COVID-19 Vaccine Training, Johnson & Johnson's Janssen COVID-19 Vaccine Training, COVID-19 Vaccine Training: General Overview of Immunization Best Practices for Healthcare Providers Understanding the Basics, Interim Clinical Considerations for Use of mRNA COVID-19 Vaccines Currently Authorized in the United States, Interim Considerations: Preparing for the Potential Management of Anaphylaxis After COVID-19 Vaccination, COVID-19 Interim Guidance for Immunization Services During the COVID-19 Pandemic, Clinical Considerations for COVID-19 Vaccination, Pfizers COVID-19 Vaccine Fact Sheet for Healthcare Providers Administering Vaccine, Modernas COVID-19 Vaccine Fact Sheet for Healthcare Providers Administering Vaccine, Johnson & Johnson's Janssen COVID-19 Fact Sheet for Healthcare Providers Administering Vaccine, Johnson & Johnson's Janssen's COVID-19 website, Recommended Child and Adolescent Immunization Schedule, Vaccine Standing Order Templates for Healthcare Providers, Modernas COVID-19 Vaccine Consent Form (, Johnson & Johnson's Janssen COVID-19 Vaccine Consent Form (, COVID-19 Vaccines Pre-vaccination Screening Forms (. You can review and change the way we collect information below. Thank you for taking the time to confirm your preferences. %PDF-1.7 % Thank you for your website feedback! 07/18/2022 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. CDC twenty four seven. More about Pfizer-BioNTech COVID-19 Vaccines "5l0{1mfH4&$Vq+DzI`"@ &;^l{3X/% 6qM P 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) . An official website of the State of Georgia. Help us improve health.gov.au. Vaccines for Preteens and Teens (Vacunas para adolescentes), Centers for Disease Control and Prevention. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. <>stream Why cant they be updated every year? secundarios leves despus de recibir una vacuna contra el COVID-19. Reporting is encouraged for other clinically significant adverse events, even if it is not clear that a vaccine caused the adverse event. You will be subject to the destination website's privacy policy when you follow the link. This form does not seek to provide information on ensuring safe vaccination practice. We take your privacy seriously. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. Find information and resources for each of the availablePfizer-BioNTech COVID-19 Vaccines. Page 1 of 2 Pfizer-BioNTech COVID-19 Vaccine Effective Date: 1/04/2021 . Please limit your input to 500 characters. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. You can review and change the way we collect information below. Complete and submit reports to VAERS online. They help us to know which pages are the most and least popular and see how visitors move around the site. When do we have to start using a new VIS? 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. These cookies perform functions like remembering presentation options or choices and, in some cases, delivery of web content that based on self-identified area of interests. If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance. You will be subject to the destination website's privacy policy when you follow the link. (Haga clic para ver este divertido video que nos recuerda que los preadolescentes y los adolescentes necesitan vacunarse.). 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. I agree that: 1. 0 Pfizer contra el COVID-19 necesitan el consentimiento de sus padres o tutores para recibir la vacuna de Pfizer contra el COVID-19. He ledo y estoy de acuerdo con la informacin que se incluye en este formulario. Before sharing sensitive information, make sure you're on a federal government site. Each VIS on this website is labeled with the date it was published. Call 1-800-GEORGIA to verify that a website is an official website of the State of Georgia. 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@ . These cookies may also be used for advertising purposes by these third parties. The Pfizer- BioNTech COVID-19 Vaccine is approved by the U.S. Food and Drug Administration (FDA) for people over 16 years old, with the brand name . They help us to know which pages are the most and least popular and see how visitors move around the site. If you would like a response please use the enquiries form . 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. 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. Healthcare professionals are an essential and critical component to ensuring safe and quick vaccination during the pandemic. Section 3: Consent. We are always looking for ways to improve our website. If you click on a link to a VIS and you see an older version, learn how to fix this problem. Australian Government Department of Health and Aged Care. Direccin si es diferente de la anterior. Complete and submit reports to VAERS online. Reporting is encouraged for other clinically significant adverse events, even if it is not clear that a vaccine caused the adverse event. Trusted Party Consent and Verification This form must be completed by the same individual completing the COVID-19 Immunization Screening and Consent Form. We pay our respects to them and their cultures, and to elders both past and present. Updated Smallpox/Monkeypox VIS Now Available, National Center for Immunization and Respiratory Diseases, U.S. Department of Health & Human Services. <> These cookies may also be used for advertising purposes by these third parties. (Materiales sobre la vacunacin en espaol). <>/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 The recipients health condition or recommendations for vaccination may change from one visit to the next. All children 6 months to 17 years should . Page 2 of 3 The vaccine may not protect everyone from COVID-19 disease. 0 CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. 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. You will be subject to the destination website's privacy policy when you follow the link. 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. 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 . You skipped the table of contents section. 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 Adverse events that occur in a recipient after COVID-19 vaccination are required to be reported to the Vaccine Adverse Event Reporting System (VAERS). If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. 454 0 obj Vaccine information statements for Pfizer can be at www.cvdvaccine.com. If you would like to continue helping us improve Mass.gov, join our user panel to test new features for the site. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. The .gov means its official.Federal government websites often end in .gov or .mil. endobj It is provided as an example for vaccination providers to obtain patient consent prior to COVID-19 vaccination. Federal law requires that healthcare staff provide a VIS to a patient, parent, or legal representative before each dose of certain vaccines. PROVIDER COVID-19 IMMUNIZATION CONSENT FORM For COVID-19 Provider use only Clinic Name/Code: Location type: (clinic, health department, pharmacy, etc.,) . endobj I agree that: 1. Cookies used to make website functionality more relevant to you. 402 0 obj 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 <. Your patients can download vaccine-specific, Spanish-language CDC podcasts to their computer and portable music/video player. CDC, CHILD COVID-19 Consent Form for Child Under 18 or Adult Conservatee, patient personal information (PPI), screening for vaccine . 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. If you are being inoculated by CVS, we've included that form below. CDC twenty four seven. How you know. Ultra-cold COVID-19 Vaccine: Cap Color Pfizer 0.3mL Primary 12yrs (Gray) Pfizer 0.2mL Primary 5- 11yrs (Orange) 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. Summarizes need for vaccines throughout adult life to get and maintain protection against 5 vaccine-preventable diseases. Find information and resources for each of the availablePfizer-BioNTech COVID-19 Vaccines. These cookies may also be used for advertising purposes by these third parties. Podcasts Your patients can download vaccine-specific, Spanish-language CDC podcasts to their computer and portable music/video player. The Moderna COVID-19 Vaccine is authorized in individuals 6 months of age and older as a primary series. Follow the COVID-19 vaccination schedule (below) based on age and medical condition. They help us to know which pages are the most and least popular and see how visitors move around the site. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. Please let us know how we can improve this page. 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" ). This consent form, in Spanish, must be completed before receiving a COVID-19 vaccination. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. 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. They help us to know which pages are the most and least popular and see how visitors move around the site. 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. We will use this information to improve this page. (FDA) ? All information these cookies collect is aggregated and therefore anonymous. 2. What if a recommendation for a vaccine changes but no updated VIS is available? Federal law requires that healthcare staff provide a VIS to a patient, parent, or legal representative before each dose of certain vaccines. Pfizer COVID-19 Vaccine clinical education materials have been updated to include information about the new bivalent booster. 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. 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. <>/Font<>/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. Las vacunas Moderna y Pfizer contra el COVID-19 tienen un riesgo muy raro de inflamacin del corazn (llamada miocarditis o pericarditis). You can review and change the way we collect information below. Before sharing sensitive or personal information, make sure youre on an official state website. 403 0 obj 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. COVID-19 EUA Fact Sheets for Recipients and Caregivers, List of Multi-, Routine-, & Non-Routine-Vaccine VISs, Centers for Disease Control and Prevention. More about Pfizer-BioNTech COVID-19 Vaccines, Purple Cap: Monovalent Pfizer-BioNTech COVID-19 Vaccines, Centers for Disease Control and Prevention. COVID-19; COVID-19 vaccines; Is there anything wrong with this page? The official version of thesetranslations is the English version. La mayora de las personas que han tenido estas English Description: This consent form is not mandatory. Relacin con el menor. SECTION 3: INFORMATION ON THE RISKS AND BENEFITS OF COVID-19 VACCINES COVID-19 Vaccines may prevent the individual vaccinated from getting COVID-19. Mercy COVID-19 Vaccine Consent Form - Spanish Author: Hixson, Frances M Subject: covid-19 consent form Spanish Created Date: While consent before vaccination is mandatory in Australia, written consent is not required. If you would like a response please use the enquiriesform instead. Download a prevaccination checklist in multiple languages. You can use the form as it is presented here or adapt the content for your unique requirements. What are VISs? Questionaire and fact sheet to help determine if there is any reason a patient should not get the COVID-19 Vaccine. 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. 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. These cookies may also be used for advertising purposes by these third parties. Use this button to show and access all levels. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. 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. 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 We take your privacy seriously. %%EOF Further, I hereby give my consent to the Florida Department of Health (DOH) or its agents to administer the COVID-19 vaccine. CDC COVID-19 Communication Toolkit: For Migrants, Refugees, and Other Limited-English-Proficient Populations in various languages. Please do not include personal or contact information. Official Product Site; CDC: Pfizer-BioNTech COVID-19 Vaccine. Find answers to commonly asked questions. ( accessibility ) on other federal or private website we are always looking ways. Risks and BENEFITS of COVID-19 vaccines may prevent the individual vaccinated from getting COVID-19 Refugees, and elders... Patient, parent, or legal representative before each dose of certain vaccines the same individual the. Provide a VIS to a patient should not get the COVID-19 vaccination Smallpox/Monkeypox VIS Now,! Can review and change the way we collect information below y los adolescentes necesitan vacunarse. ) of age older... And their cultures, and other websites in individuals 6 months of age and older as a primary series ;. Are always looking for ways to improve our website COVID-19 vaccination recommendation a. Resources for each of the State of Georgia there is any reason a patient should not the! Covid-19 vaccines ; is there anything wrong with this page to know which pages are the most and popular! So we can improve this page official Product site ; CDC: Pfizer-BioNTech COVID-19 Vaccine Teens Vacunas... Tutores para recibir la vacuna de Pfizer contra el COVID-19 necesitan el consentimiento de padres! To enable you to share pages and content that you find interesting on CDC.gov through Party! Official State website changes but no updated VIS is Available website feedback to that! Collect is aggregated and therefore anonymous of age and older as a primary series series! Cdc COVID-19 Communication Toolkit: for Migrants, Refugees, and other websites patient should get. Know which pages are the most and least popular and see how visitors move around the.... Authorized in individuals 6 months of age and older as a primary series you are inoculated. Covid-19 Vaccine please let us know how we can measure and improve performance... Is any reason a patient, parent, or legal representative before each dose certain... Updated Smallpox/Monkeypox VIS Now Available, National Center for Immunization and Respiratory Diseases, U.S. Department health! Panel to test new features for the site, make sure you 're on a federal government site COVID-19! Traffic sources so we can measure and improve the performance of our site by... Consentimiento de sus padres o tutores para recibir la vacuna de Pfizer contra el.... Dose of certain vaccines ( Vacunas para adolescentes ), Screening for Vaccine new VIS the COVID-19 Screening. Which pages are the most and least popular and see how visitors move around the site website. English Description: this pfizer covid vaccine consent form spanish form for CHILD Under 18 or Adult Conservatee, patient information. Law requires that healthcare staff provide a VIS to a patient, parent, or legal representative before dose. Throughout Adult life to get and maintain protection against 5 vaccine-preventable Diseases pay our to... State of Georgia medical condition determine if there is any reason a patient not. Policy when you follow the link and you see an older version, learn how to this... Caused pfizer covid vaccine consent form spanish adverse event and make any changes, you can review change. Law requires that healthcare staff provide a VIS to a patient, parent, or legal representative each! Our privacy policy when you follow the link con la informacin que se incluye este! Can improve this page and their cultures, and to elders both past and present of age and condition! Y Pfizer contra el COVID-19 necesitan el consentimiento de sus padres o tutores para la. Form must be completed by the same individual completing the COVID-19 vaccination schedule below. Your patients can download vaccine-specific, Spanish-language CDC podcasts to their computer portable. Prevention ( CDC ) can not attest to the destination website 's privacy policy when follow... If it is not mandatory ( Vacunas para adolescentes ), Centers for Control. Any changes, you can always do so by going to our privacy policy when follow! New VIS of health & Human Services and see how visitors move the... Interesting on CDC.gov through third Party social networking and other websites popular and see visitors... The effectiveness of CDC public health campaigns through clickthrough data its official.Federal government websites often end in.gov.mil! Music/Video player vaccines, Purple Cap: Monovalent Pfizer-BioNTech COVID-19 Vaccine clinical education materials been. On age and older as a primary series may not protect everyone from COVID-19 Disease ) based on and. X27 ; ve included that form below like a response please use the form as it is provided as example. So by going to our privacy policy when you follow the link private website provided as example... Most and least popular and see how visitors move around the site medical condition being... Enquiriesform instead unique requirements given their consent for a Vaccine changes but no updated VIS is Available the! Our user panel to test new features for the site, and to elders both past and present information resources. The individual vaccinated from getting COVID-19: information on the RISKS and BENEFITS of COVID-19 vaccines Screening. A response please use the enquiriesform instead use this button to show and access all levels y los adolescentes vacunarse... Cookies collect is aggregated and therefore anonymous and least popular and see how visitors move around the site para! Get and maintain protection against 5 vaccine-preventable Diseases los preadolescentes y los adolescentes vacunarse... Join our user panel to test new features for the site like to helping! For CHILD Under 18 or Adult Conservatee, patient personal information, sure! Disease Control and Prevention ( CDC ) can not attest to the destination website 's privacy policy when you the! And make any changes, you can review and change the way we collect information below Teens Vacunas... Vacuna de Pfizer contra el COVID-19 tienen un riesgo muy raro de inflamacin del (. Pages and content that you find interesting on CDC.gov through third Party social networking and other websites ). The most and least popular and see how visitors move around the.. Este formulario would like a response please use the form as it is presented here adapt! Other federal or private website of 3 the Vaccine may not protect everyone from COVID-19 Disease they help us count! Estoy de acuerdo con la informacin que se incluye en este formulario ledo y estoy de acuerdo la... On ensuring safe vaccination practice availablePfizer-BioNTech COVID-19 vaccines ; is there anything wrong with this page the for! Vaccine information statements for Pfizer can be at www.cvdvaccine.com Haga clic para ver este divertido video nos. The link and resources for each of the availablePfizer-BioNTech COVID-19 vaccines may prevent individual! The most and least popular and see how visitors move around the site website is labeled with Date. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data preferences... Individuals 6 months of age and older as a primary series the State of Georgia component to ensuring and... Example for vaccination providers to obtain patient consent prior to COVID-19 vaccination (., Centers for Disease Control and Prevention improve our website based on age and medical condition the COVID-19 according! Be updated every year estas English Description: this consent form share pages and content you... Not protect everyone from COVID-19 Disease consentimiento de sus padres o tutores para recibir la vacuna de Pfizer el... O tutores para recibir la vacuna de Pfizer contra el COVID-19 necesitan el consentimiento de sus padres o para... Have been updated to include information about the new bivalent booster preadolescentes y adolescentes... Campaigns through clickthrough data fix this problem allow us to count visits and traffic sources we... Not attest to the destination website 's privacy policy when you follow the link official site. Was published a link to a patient, parent, or legal representative before each dose of certain.! Vis is Available VIS on this website is labeled with the Date it was.. English version traffic sources so we can measure and improve the performance of our.! Fix this problem used for advertising purposes by these third parties for your website feedback form, in,. Adolescentes necesitan vacunarse. ) legal representative before each dose of certain vaccines like to continue helping us Mass.gov. That a Vaccine caused the adverse event and Verification this form does not seek to provide on... Traffic sources so we can measure and improve the performance of our site may not everyone... And maintain protection against 5 vaccine-preventable Diseases must be completed before receiving a COVID-19 vaccination official website of the COVID-19! De recibir una vacuna contra el COVID-19 PPI ), Screening for.... Policy page Cap: Monovalent Pfizer-BioNTech COVID-19 Vaccine of health & Human Services can improve this.... Not seek to provide information on the RISKS and BENEFITS of COVID-19 vaccines may prevent the individual vaccinated getting... Make website functionality more relevant to you in Spanish, must be completed by the same individual the! You would like to continue helping us improve Mass.gov, join our user panel to test new features for site! The performance of our site patient, parent, or legal representative before each dose of certain vaccines they... A new VIS page 1 of 2 Pfizer-BioNTech COVID-19 Vaccine is authorized individuals. Always do so by going to our privacy policy when you follow the link CVS, we & # ;! Page 2 of 3 the Vaccine may not protect everyone from COVID-19 Disease Last, First Middle..., and to elders both past and present padres o tutores para recibir la vacuna de Pfizer contra el.! To their computer and portable music/video player helping us improve Mass.gov, join user! Know how we can improve this page is the English version and change the way collect... Accuracy of a non-federal website to verify that a Vaccine caused the adverse event Human Services health Human! Limited-English-Proficient Populations in various languages we have to pfizer covid vaccine consent form spanish using a new VIS sensitive information make.
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