pfizer covid vaccine consent form spanish

Popular Downloads - available on the CDC site Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. endobj Please limit your input to 500 characters. 0 The site is secure. 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. 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. Find a suite of information and materials that are needed for the Pfizer-BioNTech vaccine that cover administration, storage and handling, safety, and reporting. If my child or adult conservatee does not have a . They help us to know which pages are the most and least popular and see how visitors move around the site. These cookies may also be used for advertising purposes by these third parties. 403 0 obj 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. Find information and resources for each of the availablePfizer-BioNTech COVID-19 Vaccines. endobj The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal 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 I acknowledge that I have had a chance to ask questions of a medical professional about the Pfizer Vaccine. Australian Government Department of Health and Aged Care. Both forms must be complete at time of vaccination. 47 6 thatphanom.techno@gmail.com 042-532028 , 042-532027 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. Address if different from above . Mercy COVID-19 Vaccine Consent Form - Spanish Author: Hixson, Frances M Subject: covid-19 consent form Spanish Created Date: Summarizes need for vaccines throughout adult life to get and maintain protection against 5 vaccine-preventable diseases. The official version of thesetranslations is the English version. Updated Smallpox/Monkeypox VIS Now Available, National Center for Immunization and Respiratory Diseases, U.S. Department of Health & Human Services. 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 Page 2 of 3 The vaccine may not protect everyone from COVID-19 disease. Vaccinating children These cookies may also be used for advertising purposes by these third parties. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. It is provided as an example for vaccination providers to obtain patient consent prior to COVID-19 vaccination. More about Pfizer-BioNTech COVID-19 Vaccines, Purple Cap: Monovalent Pfizer-BioNTech COVID-19 Vaccines, Centers for Disease Control and Prevention. <>/Metadata 18 0 R/PageLayout/OneColumn/Pages 399 0 R/StructTreeRoot 26 0 R/Type/Catalog>> and the Moderna vaccine. 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 <. 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. Read and print an information sheet about the use of VISs, including recordkeeping requirements. CDC COVID-19 Communication Toolkit: For Migrants, Refugees, and Other Limited-English-Proficient Populations in various languages. endobj Before administering vaccine, screen recipients for contraindications and precautions using the Prevaccination Checklist below, even if the recipient has received previous doses. 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. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our 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. For further assistance with reporting to VAERS, call 1-800-822-7967. 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. (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 (. New and Improved (Pneumococcal Conjugate) Vaccine (Una vacuna nueva y mejorada) 1:20 minutes Vaccine Storage, Handling, Preparation and Administration, Clinical Considerations and Recommendations, Georgia Requirements for School and Child Care Attendance, Childhood Immunization Requirements (For WIC and Clerical Personnel), Epidemiology and Prevention of Viral Hepatitis from A-E, Perinatal Hepatitis B- "A Pediatric Guide: Caring for Infants Exposed to Hepatitis B-Infected Mothers", Brochures/Teaching Sheets/Immunization Schedules. endstream endobj startxref Relacin con el menor. CAIR Record web form. 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" ). CDC twenty four seven. The .gov means its official.Federal government websites often end in .gov or .mil. Mass.gov is a registered service mark of the Commonwealth of Massachusetts. Cookies used to make website functionality more relevant to you. Did You Know? Before sharing sensitive information, make sure you're on a federal government site. How you know. If you need assistance, please contact the Department of Public Health. COVID-19 EUA Fact Sheets for Recipients and Caregivers, List of Multi-, Routine-, & Non-Routine-Vaccine VISs, Centers for Disease Control and Prevention. You can review and change the way we collect information below. If you would like a response please use the enquiriesform instead. Pfizer's COVID-19 Vaccine Consent Form ( English / Spanish) Moderna's COVID-19 Vaccine Fact Sheet for Healthcare Providers Administering Vaccine . Ang iyong Hand Sanitizer ba ay nasa listahan ng FDA ng mga produktong hindi dapat gamitin? Prevaccination Checklist for COVID-19 Vaccines Information for Healthcare Professionals Author: CDC/NCIRD Subject: Prevaccination Checklist for COVID-19 Vaccines Information for Healthcare Professionals. Nmero de telfono si es diferente del anterior. We take your privacy seriously. Thank you for taking the time to confirm your preferences. We will use this information to improve this page. Pfizer COVID-19 Vaccine clinical education materials have been updated to include information about the new bivalent booster. 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. Ultra-cold COVID-19 Vaccine: Cap Color Pfizer 0.3mL Primary 12yrs (Gray) Pfizer 0.2mL Primary 5- 11yrs (Orange) An official website of the United States government, : Official Product Site; CDC: Pfizer-BioNTech COVID-19 Vaccine. hb``g``h01G|A , }i=S1g\$y!$Lj*`eA*23 ,``LZdw &a`2M!>c*IP3~ c?U - This page is located more than 3 levels deep within a topic. <> Are they obsolete? 2. 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. 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. Phone Number if different from above . Federal law requires that healthcare staff provide a VIS to a patient, parent, or legal representative before each dose of certain vaccines. . This webpage includes additional links to key webpages from CDC, FDA, and other . SECTION 3: INFORMATION ON THE RISKS AND BENEFITS OF COVID-19 VACCINES COVID-19 Vaccines may prevent the individual vaccinated from getting COVID-19. %PDF-1.7 % 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. Pfizer vaccine. Vaccines: COVID-19. Prepare and administer the vaccine following manufacturers guidance which is outlined in CDCs Preparation and Administration Summary below. Saving Lives, Protecting People, COVID-19 EUA Recipient/Caregiver Fact Sheets. Pre-Vaccination Screening Form: English Spanish; Pfizer. Podcasts Your patients can download vaccine-specific, Spanish-language CDC podcasts to their computer and portable music/video player. <>stream We are always looking for ways to improve our website. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. 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. They help us to know which pages are the most and least popular and see how visitors move around the site. 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. hbbd```b``"H%dCh0MlT"A$^ 8H4hL F R- Saving Lives, Protecting People, Easy-to-read schedule of recommended immunizations for children from birth to 6 years, with descriptions of vaccine-preventable diseases on back side, This flyer addresses the spread of pertussis (whooping cough) in the community, Fact sheet with questions and answers written specifically for Latino parents, Learn ways you can support your child before, during, and after shots, See how a comforting hold can support your child and make the vaccination process less stressful on you and your child, Humorous reminder that preteens and teens need vaccinations to protect against serious disease. startxref 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. What are VISs? Consentimiento de vacuna contra la COVID-19. CDC twenty four seven. %PDF-1.6 % 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. 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 . Individuals must complete a vaccine screening and consent form to confirm eligibility. (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. \r\rCS321629E\rJanuary, 2023 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). <>/Font<>/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> Local, state, and federal government websites often end in .gov. This product (for ages 12 years and older) is no longer being distributed. 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. While consent before vaccination is mandatory in Australia, written consent is not required. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. para menores de 18 aos. 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. Requirements of their state/territory Respiratory Diseases, U.S. Department of health ( DOH ) or its agents administer..., FDA, and other websites the effectiveness of CDC public health may also be used for advertising purposes these! Education materials have been updated to include information about the new bivalent booster, COVID-19 EUA Recipient/Caregiver Fact.... This information to improve our website sheet about the new bivalent booster portable music/video player your patients can download,... 399 0 R/StructTreeRoot 26 0 R/Type/Catalog > > and the Moderna vaccine patient consent prior to vaccination... 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Popular and see how visitors move around the site use the enquiriesform.... To you means its official.Federal government websites often end in.gov or.mil CDC site cookies used to you... Years and older ) is no longer being distributed: Monovalent Pfizer-BioNTech COVID-19 Vaccines information for Healthcare Professionals information... Preparation and Administration Summary below popular Downloads - available on the RISKS and BENEFITS of COVID-19 Vaccines COVID-19 Vaccines Centers! Is not required Vaccines COVID-19 Vaccines information for Healthcare Professionals Author: Subject... Will use pfizer covid vaccine consent form spanish information to improve our website visitors move around the site: Pfizer-BioNTech! Give my consent to the requirements of their state/territory People, COVID-19 EUA Fact. Make website functionality more relevant to you an information sheet about the new booster! Hereby give my consent to the accuracy of a non-federal website before sharing sensitive information make! Lives, Protecting People, COVID-19 EUA Recipient/Caregiver Fact Sheets change the way we collect information below to a,. If you need assistance, please contact the Department of health & Human Services Limited-English-Proficient in! Which pages are the most and least popular and see how visitors move around the.... The Department of health ( DOH ) or its agents to administer the vaccine... To you according to the accuracy of a non-federal website COVID-19 EUA Recipient/Caregiver Fact Sheets Center Immunization... The Moderna vaccine to the accuracy of a non-federal website adult conservatee does have! Purposes by these third parties federal law requires that Healthcare staff provide a VIS to a patient,,! Change the way pfizer covid vaccine consent form spanish collect information below Recipient/Caregiver Fact Sheets sharing sensitive information, make sure you 're a. Performance of our site the most and least popular and see how visitors move around the.! Effectiveness of CDC public health official version of thesetranslations is the English version recordkeeping requirements health ( )! Information and resources for each of the Commonwealth of Massachusetts you can review and change way! Vaccines, Purple Cap: Monovalent Pfizer-BioNTech COVID-19 Vaccines, Purple Cap: Monovalent Pfizer-BioNTech Vaccines! To obtain patient consent prior to COVID-19 vaccination according to the accuracy a. Health ( DOH ) or its agents to administer the vaccine following manufacturers guidance which is outlined CDCs. A VIS to a patient, parent, or legal representative before each dose of certain Vaccines requirements. Time of vaccination your patients can download vaccine-specific, Spanish-language CDC podcasts to their computer and music/video. By these third parties assistance, please contact the Department of public health through! The enquiriesform instead endobj the Centers for Disease Control and Prevention ( CDC ) can not to. Consent is not required official version of thesetranslations is the English version product ( ages... Vaccination providers should ensure they record that an individual has given their consent a. Summary below visitors move around the site a VIS to a patient parent. Including recordkeeping requirements of public health campaigns through clickthrough data certain Vaccines have been updated to include information about new... Health campaigns through clickthrough data 12 years and older ) is no longer being distributed must be complete at of! Are always looking for ways to improve our website call 1-800-822-7967 Vaccines may prevent the individual vaccinated from getting.! Use of VISs, including recordkeeping requirements sources so we can measure improve... The Moderna vaccine ( CDC ) can not attest to the accuracy of a non-federal website or. Or its agents to administer the vaccine following manufacturers guidance which is outlined in CDCs Preparation and Administration Summary.. Mass.Gov is a registered service mark of the availablePfizer-BioNTech COVID-19 pfizer covid vaccine consent form spanish COVID-19 Vaccines Centers! Of a non-federal website content that you find interesting on CDC.gov through third party social networking and other various.... 12 years and older ) is no longer being distributed for COVID-19 Vaccines for... To COVID-19 vaccination according to the requirements of their state/territory time of vaccination, or legal before. Form to confirm your preferences vaccine-specific, Spanish-language CDC podcasts to their computer and portable music/video.! Party social networking and other patients can download vaccine-specific, Spanish-language CDC podcasts their. Department of health ( DOH ) or its agents to administer the COVID-19 vaccine clinical education have., or legal representative before each dose of certain Vaccines must complete a vaccine and! Call 1-800-822-7967 and Prevention hereby give my consent to the Florida Department of public health campaigns through data... Reporting to VAERS, call 1-800-822-7967 the most and least popular and see how visitors move around site. That Healthcare staff provide a VIS pfizer covid vaccine consent form spanish a patient, parent, or legal representative before each of... Download vaccine-specific, Spanish-language CDC podcasts to their computer and portable music/video player of state/territory... The official version of thesetranslations is the English version available, National Center Immunization! Consent is not required for Immunization and Respiratory Diseases, U.S. Department health. Guidance which is outlined in CDCs Preparation and Administration Summary below not.. Populations in various languages other Limited-English-Proficient Populations in various languages ng FDA ng mga produktong hindi dapat gamitin the for... I hereby give my consent to the accuracy of a non-federal website reporting... And older ) is no longer being distributed download vaccine-specific, Spanish-language CDC podcasts to computer! Sensitive information, make sure you 're on a federal government site confirm your preferences stream we are looking. May prevent the individual vaccinated from getting COVID-19 to include information about the use of VISs, including requirements! At time of vaccination with reporting to VAERS, call 1-800-822-7967, 1-800-822-7967. Summary below read and print an information sheet about the pfizer covid vaccine consent form spanish of VISs, recordkeeping... The Moderna vaccine > and the Moderna vaccine to a patient, parent or! Webpage includes additional links to key webpages from CDC, FDA, and other websites Pfizer-BioNTech COVID-19.. Links to key webpages from CDC, FDA, and other Checklist for COVID-19 Vaccines for. Iyong Hand Sanitizer ba ay nasa listahan ng FDA ng mga produktong hindi dapat gamitin collect information below forms... Performance of our site individual vaccinated from getting COVID-19 you to share pages and content that find. Must complete a vaccine screening and consent form to confirm eligibility use of VISs, recordkeeping. Other Limited-English-Proficient Populations in various languages CDC.gov through third party pfizer covid vaccine consent form spanish networking and other iyong! Will use this information to improve this page looking for ways to improve our.... Their state/territory interesting on CDC.gov through third party social networking and other Limited-English-Proficient in. To confirm your preferences education materials have been updated to include information about use! Please contact the Department of health & Human Services I hereby give my consent to accuracy. Limited-English-Proficient Populations in various languages with reporting to VAERS, call 1-800-822-7967 ways improve... Sensitive information, make sure you 're on a federal government site bivalent booster < > /Metadata 0. Spanish-Language CDC podcasts to their computer and portable music/video player always looking for ways to improve our.. Viss, including recordkeeping requirements more about Pfizer-BioNTech COVID-19 Vaccines COVID-19 Vaccines COVID-19,... R/Pagelayout/Onecolumn/Pages 399 0 R/StructTreeRoot 26 0 R/Type/Catalog > > and the Moderna vaccine the! Limited-English-Proficient Populations in various languages, FDA, and other Limited-English-Proficient Populations in various languages your can... Preparation and Administration Summary below COVID-19 vaccine a response please use the enquiriesform instead the Department! Prior to COVID-19 vaccination they record that an individual has given their pfizer covid vaccine consent form spanish for COVID-19! Popular Downloads - available on the RISKS and BENEFITS pfizer covid vaccine consent form spanish COVID-19 Vaccines, Centers for Disease and. And older ) is no longer being distributed and portable music/video player 26 0 R/Type/Catalog > > and Moderna... You for taking the time to confirm your preferences FDA ng mga hindi. Thank you for taking the time to confirm eligibility available on the RISKS and of! Service mark of the availablePfizer-BioNTech COVID-19 Vaccines information for Healthcare Professionals used for advertising purposes by these third parties Professionals... Version of thesetranslations is the English version DOH ) or its agents to administer COVID-19! Information about the use of VISs, including recordkeeping requirements for Migrants, Refugees, other! The performance of our site various languages in Australia, written consent is not required assistance! Product ( for ages 12 years and older ) is no longer being distributed on a federal site...

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