Summarizes need for vaccines throughout adult life to get and maintain protection against 5 vaccine-preventable diseases. Bureau of Infectious Disease and Laboratory Sciences, COVID-19 vaccinations for children and youth ages 5-17. Pfizer's COVID-19 Vaccine Consent Form ( English / Spanish) Moderna's COVID-19 Vaccine Fact Sheet for Healthcare Providers Administering Vaccine . Please do not include personal or contact information. Pre-Vaccination Screening Form: English Spanish; Pfizer. It is provided as an example for vaccination providers to obtain patient consent prior to COVID-19 vaccination. 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. Find information and resources for each of the availablePfizer-BioNTech COVID-19 Vaccines. 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. Page 2 of 3 The vaccine may not protect everyone from COVID-19 disease. They help us to know which pages are the most and least popular and see how visitors move around the site. Ang iyong Hand Sanitizer ba ay nasa listahan ng FDA ng mga produktong hindi dapat gamitin? You skipped the table of contents section. 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 (FDA) ? 2. 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 . This webpage includes additional links to key webpages from CDC, FDA, and other . Address if different from above . Vaccinating children These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. 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. Bivalent vaccine (with a maroon vial cap and different label. If you would like a response please use the enquiriesform instead. Popular Downloads - available on the CDC site Why cant they be updated every year? Complete and submit reports to VAERS online. 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. 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. If you do modify the form, please ensure you remove the Australian Government and COVID-19 Vaccination branding. Further, I hereby give my consent to the Florida Department of Health (DOH) or its agents to administer the COVID-19 vaccine. I understand that the Pfizer Vaccine will be given in two . Use this button to show and access all levels. They help us to know which pages are the most and least popular and see how visitors move around the site. . This form does not seek to provide information on ensuring safe vaccination practice. While consent before vaccination is mandatory in Australia, written consent is not required. 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. Pfizer COVID-19 Vaccine clinical education materials have been updated to include information about the new bivalent booster. Before sharing sensitive or personal information, make sure youre on an official state website. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. If you need assistance, please contact the Department of Public Health. You can review and change the way we collect information below. "5l0{1mfH4&$Vq+DzI`"@ &;^l{3X/% 6qM P 07/18/2022 This consent form is not mandatory. You can review and change the way we collect information below. We will use this information to improve this page. vacuna contra la COVID-19 de Pfizer o Moderna. This webpage providers information and materials for historical reference only. <> (Check back as we will continue to. Thank you for your website feedback! Prevaccination Checklist for COVID-19 Vaccines Information for Healthcare Professionals Author: CDC/NCIRD Subject: Prevaccination Checklist for COVID-19 Vaccines Information for Healthcare Professionals. Thank you for taking the time to confirm your preferences. 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 <. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. A lock icon ( 402 0 obj We take your privacy seriously. If my child or adult conservatee does not have a . ) or https:// means youve safely connected to the official website. 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. secundarios leves despus de recibir una vacuna contra el COVID-19. You will be subject to the destination website's privacy policy when you follow the link. Consent: I have the legal authority and have provided consent to the administration of the Pfizer-BioNTech COVID-19 Vaccine to Pfizer contra el COVID-19 necesitan el consentimiento de sus padres o tutores para recibir la vacuna de Pfizer contra el COVID-19. Before sharing sensitive information, make sure you're on a federal government 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. CDC twenty four seven. If you are being inoculated by CVS, we've included that form below. Podcasts Your patients can download vaccine-specific, Spanish-language CDC podcasts to their computer and portable music/video player. New and Improved (Pneumococcal Conjugate) Vaccine (Una vacuna nueva y mejorada) 1:20 minutes 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. Please limit your input to 500 characters. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. . 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). Prepare and administer the vaccine following manufacturers guidance which is outlined in CDCs Preparation and Administration Summary below. How you know. Cookies used to make website functionality more relevant to you. Vaccines for Preteens and Teens (Vacunas para adolescentes), Centers for Disease Control and Prevention. PROVIDER COVID-19 IMMUNIZATION CONSENT FORM For COVID-19 Provider use only Clinic Name/Code: Location type: (clinic, health department, pharmacy, etc.,) . The recipients health condition or recommendations for vaccination may change from one visit to the next. The feedback will only be used for improving the website. COVID-19 Vaccine Consent Form for Individuals 17 Years of Age or Younger. Vaccine Information Statements (VISs) are information sheets produced by the CDC that explain both the benefits and risks of a vaccine to vaccine recipients. 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. To receive email updates about this page, enter your email address: We take your privacy seriously. We hope that you find these translations useful. 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. While most patients may speak English, they may better understand about vaccines and vaccine-preventable diseases when the information is written in Spanish. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. Please let us know how we can improve this page. Vaccine information statements for Pfizer can be at www.cvdvaccine.com. 431 0 obj You can review and change the way we collect information below. Direccin si es diferente de la anterior. Updated Smallpox/Monkeypox VIS Now Available, National Center for Immunization and Respiratory Diseases, U.S. Department of Health & Human Services. 404 0 obj Vaccines: COVID-19. This product (for ages 12 years and older) is no longer being distributed. endobj We aim to provide documents in an accessible format. Ultra-cold COVID-19 Vaccine: Cap Color Pfizer 0.3mL Primary 12yrs (Gray) Pfizer 0.2mL Primary 5- 11yrs (Orange) COVID-19. Research has continued to show that vaccines prevent serious illness, hospitalization, and death from COVID-19. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. 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 Healthcare professionals are an essential and critical component to ensuring safe and quick vaccination during the pandemic. 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. All information these cookies collect is aggregated and therefore anonymous. Please limit your input to 500 characters. 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. We take your privacy seriously. CDC twenty four seven. 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. If you would like a response please use the enquiries form . If you would like to continue helping us improve Mass.gov, join our user panel to test new features for the site. 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. Trusted Party Consent and Verification This form must be completed by the same individual completing the COVID-19 Immunization Screening and Consent Form. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. This fun 30-second video (in Spanish) reminds us that preteens and teens need shots. Did You Know? Healthcare professionals in the United States serve patients of many nationalities, including many Spanish-speaking citizens and visitors. 47 6 thatphanom.techno@gmail.com 042-532028 , 042-532027 A range of additional resources to support vaccination providers is available. CDC twenty four seven. An official website of the State of Georgia. \r\rCS321629E\rJanuary, 2023 An official website of the State of Georgia. Cookies used to make website functionality more relevant to you. Esto se ve ms comnmente en hombres menores de 30 aos despus de la segunda dosis. Top-requested sites to log in to services provided by the state. 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) . State of Georgia government websites and email systems use georgia.gov or ga.gov at the end of the address. Both forms must be complete at time of vaccination. Share sensitive information only on official, secure websites. 170 0 obj <> endobj These cookies may also be used for advertising purposes by these third parties. The official version of thesetranslations is the English version. (Haga clic para ver este divertido video que nos recuerda que los preadolescentes y los adolescentes necesitan vacunarse.). English Espaol (Spanish) CDC COVID-19 Communication Toolkit: For Migrants, Refugees, and Other Limited-English-Proficient Populations in various languages Pfizer-BioNTech COVID-19. 0 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. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. 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. 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. 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