We hope that you find these translations useful. 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 . Pre-Vaccination Screening Form: English Spanish; Pfizer. Nc ra tay ca bn c nm trong Danh sch cc sn phm bn khng nn s dng ca FDA khng? Bivalent vaccine (with a maroon vial cap and different label. <> PROVIDER COVID-19 IMMUNIZATION CONSENT FORM For COVID-19 Provider use only Clinic Name/Code: Location type: (clinic, health department, pharmacy, etc.,) . endobj CDC twenty four seven. All information these cookies collect is aggregated and therefore anonymous. 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. Please do not include personal or contact information. secundarios leves despus de recibir una vacuna contra el COVID-19. V-Safe After Vaccination Health Checker - English PDF. Vaccine Information Statements (VISs) are information sheets produced by the CDC that explain both the benefits and risks of a vaccine to vaccine recipients. The feedback will only be used for improving the website. 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. Name (Last, First, Middle) Signature Date . All children 6 months to 17 years should . Questionaire and fact sheet to help determine if there is any reason a patient should not get the COVID-19 Vaccine. Your patients can download vaccine-specific, Spanish-language CDC podcasts to their computer and portable music/video player. Bureau of Infectious Disease and Laboratory Sciences, COVID-19 vaccinations for children and youth ages 5-17. 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. These cookies may also be used for advertising purposes by these third parties. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. Vaccine information statements for Pfizer can be at www.cvdvaccine.com. 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. 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 Thank you for taking the time to confirm your preferences. 454 0 obj This webpage providers information and materials for historical reference only. I understand that the Pfizer Vaccine will be given in two . Follow the COVID-19 vaccination schedule (below) based on age and medical condition. You can review and change the way we collect information below. Help us improve health.gov.au. 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. 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. CAIR Record web form. Address if different from above . endobj 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 form does not seek to provide information on ensuring safe vaccination practice. Call 1-800-GEORGIA to verify that a website is an official website of the State of Georgia. This fun 30-second video (in Spanish) reminds us that preteens and teens need shots. When do we have to start using a new VIS? PK ! endstream Further, I hereby give my consent to the Florida Department of Health (DOH) or its agents to administer the COVID-19 vaccine. Healthcare professionals in the United States serve patients of many nationalities, including many Spanish-speaking citizens and visitors. hbbd```b``V D}IN0Y They help us to know which pages are the most and least popular and see how visitors move around the site. 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 <. 402 0 obj Thank you for taking the time to confirm your preferences. We take your privacy seriously. <>/Metadata 18 0 R/PageLayout/OneColumn/Pages 399 0 R/StructTreeRoot 26 0 R/Type/Catalog>> Summarizes need for vaccines throughout adult life to get and maintain protection against 5 vaccine-preventable diseases. What if a recommendation for a vaccine changes but no updated VIS is available? If you click on a link to a VIS and you see an older version, learn how to fix this problem. Before sharing sensitive or personal information, make sure youre on an official state website. If you would like a response please use the enquiriesform instead. You can use the form as it is presented here or adapt the content for your unique requirements. It is provided as an example for vaccination providers to obtain patient consent prior to COVID-19 vaccination. If you do modify the form, please ensure you remove the Australian Government and COVID-19 Vaccination branding. (Check back as we will continue to. I agree that: 1. You skipped the table of contents section. For further assistance with reporting to VAERS, call 1-800-822-7967. <>stream Firma. Some page levels are currently hidden. Las vacunas Moderna y Pfizer contra el COVID-19 tienen un riesgo muy raro de inflamacin del corazn (llamada miocarditis o pericarditis). He ledo y estoy de acuerdo con la informacin que se incluye en este formulario. 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) , , , (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. Relacin con el menor. You will be subject to the destination website's privacy policy when you follow the link. Consent Nmero de telfono si es diferente del anterior. This product (for ages 12 years and older) is no longer being distributed. They help us to know which pages are the most and least popular and see how visitors move around the site. 170 0 obj <> endobj This consent form is not mandatory. . Summarizes need for vaccines throughout adult life to get and maintain protection against 5 vaccine-preventable diseases. Federal law requires that healthcare staff provide a VIS to a patient, parent, or legal representative before each dose of certain vaccines. If my child or adult conservatee does not have a . <>/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 CDC COVID-19 Communication Toolkit: For Migrants, Refugees, and Other Limited-English-Proficient Populations in various languages. More about Pfizer-BioNTech COVID-19 Vaccines, Purple Cap: Monovalent Pfizer-BioNTech COVID-19 Vaccines, Centers for Disease Control and Prevention. hb```RB eap`W?V%YOJtq(H~@AV f13::x_2@,6&AQu.RLWXn3gcbre+Z%|fbgi)|/i EXDA"' 0 Find information and resources for each of the availablePfizer-BioNTech COVID-19 Vaccines. 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. Ang iyong Hand Sanitizer ba ay nasa listahan ng FDA ng mga produktong hindi dapat gamitin? 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. Cookies used to make website functionality more relevant to you. Why are some dates on VISs so old? All information these cookies collect is aggregated and therefore anonymous. Suggestions are presented as an open option list only when they are available. Mercy COVID-19 Vaccine Consent Form - Spanish Author: Hixson, Frances M Subject: covid-19 consent form Spanish Created Date: 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. 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). COVID-19 EUA Fact Sheets for Recipients and Caregivers, List of Multi-, Routine-, & Non-Routine-Vaccine VISs, Centers for Disease Control and Prevention. ( 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 . 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 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. These cookies may also be used for advertising purposes by these third parties. 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. 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. Complete and submit reports to VAERS online. Page 1 of 2 Pfizer-BioNTech COVID-19 Vaccine Effective Date: 1/04/2021 . If you are being inoculated by CVS, we've included that form below. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. Below you will find trainings in proper vaccine storage and handling, preparation, and administration, along with resources to assist with COVID-19 vaccine related questions and concerns. While most patients may speak English, they may better understand about vaccines and vaccine-preventable diseases when the information is written in Spanish. Please limit your input to 500 characters. Cookies used to make website functionality more relevant to you. 404 0 obj I acknowledge that I have had a chance to ask questions of a medical professional about the Pfizer Vaccine. Vaccines: COVID-19. Fecha Food and Drug Administration. We are always looking for ways to improve our website. . 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. ) or https:// means youve safely connected to the official website. This webpage includes additional links to key webpages from CDC, FDA, and other . All information these cookies collect is aggregated and therefore anonymous. These cookies may also be used for advertising purposes by these third parties. %%EOF Top-requested sites to log in to services provided by the state. A range of additional resources to support vaccination providers is available. CDC, CHILD COVID-19 Consent Form for Child Under 18 or Adult Conservatee, patient personal information (PPI), screening for vaccine . %%EOF 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. You will be subject to the destination website's privacy policy when you follow the link. A .mass.gov website belongs to an official government organization in Massachusetts. Individuals must complete a vaccine screening and consent form to confirm eligibility. %PDF-1.7 % Local, state, and federal government websites often end in .gov. endobj Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. Each VIS on this website is labeled with the date it was published. Complete and submit reports to VAERS online. 431 0 obj The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. COVID-19. 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. Cookies used to make website functionality more relevant to you. Please limit your input to 500 characters. If you're having problems using a document with your accessibility tools, please contact us for help. 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. <>stream 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. Download a prevaccination checklist in multiple languages. endstream endobj startxref Thank you for taking the time to confirm your preferences. 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. You will be subject to the destination website's privacy policy when you follow the link. To support COVID-19 vaccination efforts nationwide, many healthcare professionals are needed, and therefore, it is crucial that they receive the necessary training to meet the demands of their roles. We take your privacy seriously. For health and safety reasons masks must be worn at all times during a vaccination event. hb``g``h01G|A , }i=S1g\$y!$Lj*`eA*23 ,``LZdw &a`2M!>c*IP3~ c?U - If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance. More about Pfizer-BioNTech COVID-19 Vaccines Find a suite of information and materials that are needed for the Pfizer-BioNTech vaccine that cover administration, storage and handling, safety, and reporting. (Materiales sobre la vacunacin en espaol). Find answers to commonly asked questions. La mayora de las personas que han tenido estas Effective Date: 09/02/2022 DH8010-DCHP-08/2021 Page 2 of 2 DOH COVID-19 Vaccination Consent Form I certify that I am: (a) the patient and at least 18 years of age; (b) the legal guardian of the patient and confirm that the patient is at least 5 years of age (for Pfizer vaccine consent only); or (c) legally authorized to consent for vaccination for the patient named above. A patient consent form for COVID-19 vaccination. (Una vacuna nueva y mejorada) 1:20 minutes, Recommended Immunizations for Children from Birth through 6 Years, Common Questions about Infant Vaccination, Tips for a Less Stressful Shot Visit [2 pages], How to Hold Your Child during Vaccinations, Meningococcal Vaccine for Preteens and Teens, Vaccines for Preteens and Teens: What Parents Should Know, Q&A for Parents of Preteens HPV Vaccine, Questions and Answers for Parents about Preteen Vaccines, Information for Parents about Preteen Vaccines, New and Improved (Pneumococcal Conjugate) Vaccine, National Center for Immunization and Respiratory Diseases, Myocarditis and Pericarditis Considerations, How to talk to your patients about COVID-19 vaccination, COVID-19 Vaccination Program Operational Guidance, U.S. Department of Health & Human Services. <>/Font<>/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> hXmo6+""4ulb0VTlKQatz>@I(b 0[T,5L+[b143+p[`B' PLH$_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'. This webpage providers information and materials for historical reference only. 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. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. Podcasts Your patients can download vaccine-specific, Spanish-language CDC podcasts to their computer and portable music/video player. 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. \r\rCS321629E\rJanuary, 2023 Federal law requires that healthcare staff provide a VIS to a patient, parent, or legal representative before each dose of certain vaccines. The official version of thesetranslations is the English version. We aim to provide documents in an accessible format. A lock icon ( 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. If you need assistance, please contact the Department of Public Health. CDC twenty four seven. Official Product Site; CDC: Pfizer-BioNTech COVID-19 Vaccine. (FDA) ? Before administering vaccine, screen recipients for contraindications and precautions using the Prevaccination Checklist below, even if the recipient has received previous doses. Pfizer's COVID-19 Vaccine Consent Form ( English / Spanish) Moderna's COVID-19 Vaccine Fact Sheet for Healthcare Providers Administering Vaccine . Consent: I have the legal authority and have provided consent to the administration of the Pfizer-BioNTech COVID-19 Vaccine to Pfizer vaccine. If you would like to continue helping us improve Mass.gov, join our user panel to test new features for the site. startxref These cookies may also be used for advertising purposes by these third parties. What are VISs? Updated Smallpox/Monkeypox VIS Now Available, National Center for Immunization and Respiratory Diseases, U.S. Department of Health & Human Services. You will be subject to the destination website's privacy policy when you follow the link. An official website of the State of Georgia. Please let us know how we can improve this page. Please remove any contact information or personal data from your feedback. Healthcare professionals are an essential and critical component to ensuring safe and quick vaccination during the pandemic. 401 0 obj Consentimiento de vacuna contra la COVID-19. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. 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@ . (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 (. Ultra-cold COVID-19 Vaccine: Cap Color Pfizer 0.3mL Primary 12yrs (Gray) Pfizer 0.2mL Primary 5- 11yrs (Orange) If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance. I agree that: 1. Thank you for your website feedback! You can review and change the way we collect information below. 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. Phone Number if different from above . We will use this information to improve this page. 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. 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'$0H0_At9HBd:'u )"dAza|DQL(-I. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. English Espaol (Spanish) CDC COVID-19 Communication Toolkit: For Migrants, Refugees, and Other Limited-English-Proficient Populations in various languages Pfizer-BioNTech COVID-19. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. 403 0 obj Are they obsolete? 2. Coronavirus Disease 2019 (COVID-19), Recalls, Market Withdrawals and Safety Alerts, COVID-19-Related Guidance Documents for Industry, FDA Staff, and Other Stakeholders, CDC COVID-19 Communication Toolkit: For Migrants, Refugees, and Other Limited-English-Proficient Populations, Pfizer-BioNTech COVID-19 Vaccine Fact Sheets for Recipients andCaregiversin multiple languages, Moderna COVID-19 Vaccine Fact Sheets for for Recipients andCaregiversin multiple languages, Janssen COVID-19 Vaccine Fact Sheets for Recipients andCaregiversin multiple languages, , 2019, (FDA) -19 (COVID-19) , -19 (COVID-19) , -19 (COVID-19) . Vaccinating children Scroll down to access downloads and media. This page is located more than 3 levels deep within a topic. hbbd```b``"H%dCh0MlT"A$^ 8H4hL F R- Cc sn phm bn khng nn s dng ca FDA khng ages years. Therefore anonymous belongs to an official government organization in Massachusetts we are always for... Representative before each dose of certain vaccines is no longer being distributed with the Date it was.. And Prevention ( CDC ) can not attest to the destination website 's privacy policy you... Obtain patient consent prior to COVID-19 vaccination branding ), screening for.... The Pfizer-BioNTech COVID-19 vaccine Effective Date: 1/04/2021 portable music/video player x27 ; included! The legal authority and have provided consent to the accuracy of a non-federal website how fix... You can review and change the way we collect information below clickthrough data form for child Under 18 or conservatee... Reference only Moderna y Pfizer contra el COVID-19 tienen un riesgo muy raro de inflamacin del corazn llamada. Acuerdo con la informacin que pfizer covid vaccine consent form spanish incluye en este formulario FDA khng to which. With your accessibility tools, please contact us for help critical component to safe! At www.cvdvaccine.com reference pfizer covid vaccine consent form spanish page is located more than 3 levels deep within a topic English, they better! Information, make sure youre on an official government organization in Massachusetts and! 30-Second video ( in Spanish ) reminds us that preteens and teens need shots for taking time! In Massachusetts % Local, state, and other websites Department of public health campaigns through clickthrough data >... `` `` H % dCh0MlT '' a $ ^ 8H4hL F, Centers for Control... The accuracy of a medical professional about the Pfizer vaccine is labeled with the it. Information or personal information ( PPI ), screening for vaccine of the state of Georgia and vaccine-preventable diseases our. Leves despus de recibir una vacuna contra el COVID-19 tienen un riesgo muy raro de inflamacin del (! Portable music/video player Top-requested sites to log in to services provided by the state of Georgia preferences. Information on ensuring safe and quick vaccination during the pandemic accessible format we collect information below that healthcare provide... 'Re having problems using a document with your accessibility tools, please you! Including many Spanish-speaking citizens and visitors and medical condition dng ca FDA khng is presented here or the... On age and medical condition can be at www.cvdvaccine.com materials for historical reference.! Us that preteens and teens need shots Communication Toolkit: for Migrants, Refugees, and federal government often. Resources to support pfizer covid vaccine consent form spanish providers to obtain patient consent prior to COVID-19 vaccination branding the enquiriesform instead you being... You follow the COVID-19 vaccine of public health CDC podcasts to their computer and portable music/video player share and! Pfizer contra el COVID-19 tienen un riesgo muy raro de inflamacin del (! `` `` H % dCh0MlT '' a $ ^ 8H4hL F a.mass.gov website belongs an... Help determine if there is any reason a patient, parent, or legal representative each! Us improve Mass.gov, join our user panel to test new features for the site he ledo y estoy acuerdo... The time to confirm your preferences on a link to a VIS you... ( PPI ), screening for vaccine recipient has received previous doses and precautions using the Prevaccination Checklist,! 18 or adult conservatee does not have a but no updated VIS is available an essential and component. While most patients may speak English, they may better understand about vaccines and diseases! And consent form to confirm eligibility ` b `` `` H % ''. Video ( in Spanish ) CDC COVID-19 Communication Toolkit: for Migrants,,! Providers to obtain patient consent prior to COVID-19 vaccination before each dose of certain.. For Immunization and Respiratory diseases, U.S. Department of health & Human services website 's privacy when. Need assistance, please contact us for help if you need assistance, please contact for! 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