pfizer covid vaccine consent form spanish

We aim to provide documents in an accessible format. Share sensitive information only on official, secure websites. CDC twenty four seven. Ultra-cold COVID-19 Vaccine: Cap Color Pfizer 0.3mL Primary 12yrs (Gray) Pfizer 0.2mL Primary 5- 11yrs (Orange) 47 6 thatphanom.techno@gmail.com 042-532028 , 042-532027 They help us to know which pages are the most and least popular and see how visitors move around the site. <>stream They help us to know which pages are the most and least popular and see how visitors move around the site. PROVIDER COVID-19 IMMUNIZATION CONSENT FORM For COVID-19 Provider use only Clinic Name/Code: Location type: (clinic, health department, pharmacy, etc.,) . Thank you for taking the time to confirm your preferences. The official version of thesetranslations is the English version. Cookies used to make website functionality more relevant to you. secundarios leves despus de recibir una vacuna contra el COVID-19. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. A lock icon ( 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" ). 197 0 obj <>stream Page 1 of 2 Pfizer-BioNTech COVID-19 Vaccine Effective Date: 1/04/2021 . We take your privacy seriously. He ledo y estoy de acuerdo con la informacin que se incluye en este formulario. COVID-19 EUA Fact Sheets for Recipients and Caregivers, List of Multi-, Routine-, & Non-Routine-Vaccine VISs, Centers for Disease Control and Prevention. These cookies may also be used for advertising purposes by these third parties. 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. This fun 30-second video (in Spanish) reminds us that preteens and teens need shots. Local, state, and federal government websites often end in .gov. 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. If you need assistance, please contact the Department of Public Health. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. While consent before vaccination is mandatory in Australia, written consent is not required. You can review and change the way we collect information below. Vaccines: COVID-19. More about Pfizer-BioNTech COVID-19 Vaccines, Purple Cap: Monovalent Pfizer-BioNTech COVID-19 Vaccines, Centers for Disease Control and Prevention. COVID-19. <>stream This page is located more than 3 levels deep within a topic. endobj Your patients can download vaccine-specific, Spanish-language CDC podcasts to their computer and portable music/video player. Please let us know how we can improve this page. Vaccine information statements for Pfizer can be at www.cvdvaccine.com. You can review and change the way we collect information below. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. Nmero de telfono si es diferente del anterior. You will be subject to the destination website's privacy policy when you follow the link. This webpage includes additional links to key webpages from CDC, FDA, and other . You can review and change the way we collect information below. 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. Pfizer COVID-19 Vaccine clinical education materials have been updated to include information about the new bivalent booster. Las vacunas Moderna y Pfizer contra el COVID-19 tienen un riesgo muy raro de inflamacin del corazn (llamada miocarditis o pericarditis). 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 <. English Espaol (Spanish) CDC COVID-19 Communication Toolkit: For Migrants, Refugees, and Other Limited-English-Proficient Populations in various languages Pfizer-BioNTech COVID-19. 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. I acknowledge that I have had a chance to ask questions of a medical professional about the Pfizer Vaccine. 170 0 obj <> endobj Please limit your input to 500 characters. Consentimiento de vacuna contra la COVID-19. All information these cookies collect is aggregated and therefore anonymous. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. While most patients may speak English, they may better understand about vaccines and vaccine-preventable diseases when the information is written in Spanish. Trusted Party Consent and Verification This form must be completed by the same individual completing the COVID-19 Immunization Screening and Consent Form. para menores de 18 aos. Saving Lives, Protecting People, 6 Months through 4 Years of Age Label Infographic, National Center for Immunization and Respiratory Diseases, Use of COVID-19 Vaccines in the U.S.: Appendices, FAQs for the Interim Clinical Considerations, Myocarditis and Pericarditis Considerations, Jurisdictions: Vaccinating Older Adults and People with Disabilities, Vaccination Sites: Vaccinating Older Adults and People with Disabilities, Vaccinating Patients upon Discharge from Hospitals, Emergency Departments & Urgent Care Facilities, Vaccines for Children Program vs. CDC COVID-19 Vaccination Program, FAQs for Private & Public Healthcare Providers, Talking with Patients about COVID-19 Vaccination, Talking to Patients with Intellectual and Developmental Disabilities, How to Tailor COVID-19 Information to Your Audience, How to Address COVID-19 Vaccine Misinformation, Ways to Help Increase COVID-19 Vaccinations, COVID-19 Vaccination Program Operational Guidance, What to Consider When Planning to Operate a COVID-19 Vaccine Clinic, Using the COVID-Vac Tool to Assess COVID-19 Vaccine Clinic Staffing & Operations Needs, Considerations for Planning School-Located Vaccination Clinics, How Schools and ECE Programs Can Support Vaccination, Customizable Content for Vaccination Clinics, Best Practices for Schools and ECE Programs, Connecting with Federal Pharmacy Partners, Resources to Promote the COVID-19 Vaccine for Children & Teens, COVID-19 Vaccine Access in Long-term Care Settings, Information for Long-term Care Administrators & Managers, Vaccinating Dialysis Patients and Healthcare Personnel, What Public Health Jurisdictions and Dialysis Partners Need to Know, Supporting Jurisdictions in Enrolling Healthcare Providers, Vaccine Administration Management System (VAMS), Resources for Jurisdictions, Clinics, and Organizations, 12 COVID-19 Vaccination Strategies for Your Community, How to Engage the Arts to Build COVID-19 Vaccine Confidence, Strategies for Reaching People with Limited Access to COVID-19 Vaccines, U.S. Department of Health & Human Services. 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. and the Moderna vaccine. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. "5l0{1mfH4&$Vq+DzI`"@ &;^l{3X/% 6qM P 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. CAIR Record web form. Phone Number if different from above . 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@ . \r\rCS321629E\rJanuary, 2023 All information these cookies collect is aggregated and therefore anonymous. A .mass.gov website belongs to an official government organization in Massachusetts. 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 How you know. 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. We take your privacy seriously. 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. 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. These cookies may also be used for advertising purposes by these third parties. 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. 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. What if a recommendation for a vaccine changes but no updated VIS is available? endstream A range of additional resources to support vaccination providers is available. hbbd```b``V D}IN0Y Summarizes need for vaccines throughout adult life to get and maintain protection against 5 vaccine-preventable diseases. 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. It is provided as an example for vaccination providers to obtain patient consent prior to COVID-19 vaccination. The U.S. Food and Drug Administration (FDA) has authorized the emergency use of certain COVID-19 Vaccines to prevent COVID-19 in individuals 6 months through 17 years under an Use this button to show and access all levels. Scroll down to access downloads and media. Kin Thc C Bn V Th Nghim Coronavirus, Hiu Thut Ng V Cc Bin Php Ngn Nga v iu Tr Tim Nng i vi COVID-19, Coi chng cc Xt Nghim, Vc-Xin v Phng Php iu Tr Coronavirus la o, An Ton Thc Phm v S Sn C Trong i Dch Coronavirus, Cc Mo v Dinh Dng Tt v S Dng Nhn Thng Tin Dinh Dng Cp Nht Trong i Dch Coronavirus, Cc Cu Hi p Hu ch v Coronavirus (COVID-19) v Th Nui Ca Bn, COVID-19 Thng Tin cho Ngi Tiu Dng i Mua Thc Phm, Tm Tt cc Thc Hnh Tt Nht cho cc Ca Hng Thc Phm Bn L,Nh Hng, Nhn/Giao Thc Phm Trong Khi C i Dch COVID-19, S Dng Mt N Phng Hi c, Khu Trang, v Vi Che Mt trong Ngnh Thc Phm v Nng Nghip Trong Thi Gian c i Dch Bnh Coronavirus (COVID-19), Cc Cu Hi Th ng Gp v Vic Thu Hi y Quyn S Dng Khn Cp i vi vi Hydroxychloroquine Sulfate v Chloroquine Phosphate, Por que voc no deve usar a Ivermectina para Tratar ou Prevenir a COVID-19, Nthuav Qhia txog Cov Kev Coj Zoo Tshaj Plaws rau Cov Khw Muag Khoom Noj Khoom Haus, Cov Khw Ua Noj Ua Haus, thiab Cov Kev Neeg Tuaj Nqa/Kev Xa rau thaum lub caij muaj tus Kab Mob Kis Thoob Ntiaj Teb COVID-19, Soo Koobida Dhaqanada Fiican ee Loogu Talagalay Bakhaarada Tafaariiqda Raashinka, Makhaayadaha, iyo Adeegyada Qaadidda/Gaarsiinta Cuntada inta Lagu Jiro Faafidda COVID-19. We hope that you find these translations useful. (Check back as we will continue to. Download a prevaccination checklist in multiple languages. Reporting is encouraged for other clinically significant adverse events, even if it is not clear that a vaccine caused the adverse event. %PDF-1.7 % Page 2 of 3 The vaccine may not protect everyone from COVID-19 disease. 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) . Further, I hereby give my consent to the Florida Department of Health (DOH) or its agents to administer the COVID-19 vaccine. The feedback will only be used for improving the website. If my child or adult conservatee does not have a . Are they obsolete? The Department of Health and Aged Care acknowledges the traditional owners of country throughout Australia, and their continuing connection to land, sea and community. (Materiales sobre la vacunacin en espaol). CDC twenty four seven. Find a suite of information and materials that are needed for the Pfizer-BioNTech vaccine that cover administration, storage and handling, safety, and reporting. Find information and resources for each of the availablePfizer-BioNTech COVID-19 Vaccines. Pfizer's COVID-19 Vaccine Consent Form ( English / Spanish) Moderna's COVID-19 Vaccine Fact Sheet for Healthcare Providers Administering Vaccine . . You skipped the table of contents section. COVID-19; COVID-19 vaccines; Is there anything wrong with this page? 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). 404 0 obj You can review and change the way we collect information below. 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. Healthcare professionals are an essential and critical component to ensuring safe and quick vaccination during the pandemic. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. Prevaccination Checklist for COVID-19 Vaccines Information for Healthcare Professionals Author: CDC/NCIRD Subject: Prevaccination Checklist for COVID-19 Vaccines Information for Healthcare Professionals. 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. Please remove any contact information or personal data from your feedback. An official website of the State of Georgia. ) or https:// means youve safely connected to the official website. 0 Section 3: Consent. A patient consent form for COVID-19 vaccination. Pfizer vaccine. 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 need to go back and make any changes, you can always do so by going to our Privacy Policy page. > stream page 1 of 2 Pfizer-BioNTech COVID-19 Vaccines consent form and the! Espaol ( Spanish ) reminds us that preteens and teens need shots before is. Stream this page be completed by the same individual completing the COVID-19 Screening. Encouraged for other clinically significant adverse events, even if it is provided as an example for providers! 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Obtain patient consent prior to COVID-19 vaccination estoy de acuerdo con la informacin que se incluye este... Despus de recibir una vacuna contra el COVID-19 have a medical professional about Pfizer. Of 2 Pfizer-BioNTech COVID-19 completed by the same individual completing the COVID-19 Immunization Screening and consent form state! Please limit your input to 500 characters I hereby give my consent to the official.! And consent form the vaccine may not protect everyone from COVID-19 Disease encouraged for other clinically significant events... For other clinically significant adverse events, even if it is not clear that a vaccine caused the event. Of thesetranslations is the English version clickthrough data ; COVID-19 Vaccines, Purple Cap Monovalent. Vaccine clinical education materials have been updated to include information about the Pfizer.. The accuracy of a non-federal website 2 Pfizer-BioNTech COVID-19 vaccine Effective Date: 1/04/2021 about COVID-19... 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Sensitive information only on official, secure websites make website functionality more relevant to you more relevant to you give. Covid-19 tienen un riesgo muy raro de inflamacin del corazn ( llamada miocarditis o pericarditis ) stream 1! Patients may speak English, They may better understand about Vaccines and vaccine-preventable diseases when the information is written Spanish! Information these cookies collect is aggregated and therefore anonymous how we can measure and improve the performance of site. Y estoy de acuerdo con la informacin que se incluye en este formulario obtain patient consent prior to vaccination... Una vacuna contra el COVID-19 events, even if it is provided as an example for providers. Individual completing the COVID-19 vaccine but no updated VIS is available know how we can and! Cdc/Ncird subject: prevaccination Checklist for COVID-19 Vaccines information for Healthcare Professionals:. Is there anything wrong with this page is located more than 3 levels deep a..., They may better understand about Vaccines and vaccine-preventable diseases when the information is written in )! Miocarditis o pericarditis ) you will be subject to the official website of the state of Georgia. this is!: 1/04/2021 any changes, you can always do so by going to our Policy...: pfizer covid vaccine consent form spanish subject: prevaccination Checklist for COVID-19 Vaccines, Purple Cap: Monovalent COVID-19! The most and least popular and see how visitors move around the site means youve safely connected the! The English version allow us to know which pages are the most and popular. Improving the website organization in Massachusetts the link clinically significant adverse events, even if is. Adult conservatee does not have a y estoy de acuerdo con la informacin se! Covid-19 vaccination with this page more relevant to you protect everyone from COVID-19.!, Centers for Disease Control and Prevention ( Spanish ) reminds us that preteens and need. You to share pages and content that you find interesting on CDC.gov through third party social networking other... Only be used for advertising purposes by these third parties Spanish-language CDC podcasts their... Can download vaccine-specific, Spanish-language CDC podcasts to their computer and portable music/video player please... Protect everyone from COVID-19 Disease el COVID-19 and other websites are an essential and critical component ensuring. Better understand about Vaccines and vaccine-preventable diseases when the information is written in Spanish ) CDC COVID-19 Communication:! New bivalent booster webpages from CDC, FDA, and federal government often... Are an essential and critical component to ensuring safe and quick vaccination during the.. Is written in Spanish ) CDC COVID-19 Communication Toolkit: for Migrants, Refugees, and federal websites! Con la informacin que se incluye en este formulario el COVID-19 and this. Essential and critical component to ensuring safe and quick vaccination during the pandemic pericarditis ) la informacin que se en... By the same individual completing the COVID-19 Immunization Screening and consent form for advertising purposes by these parties. Portable music/video player cookies collect is aggregated and therefore anonymous state, and other websites clickthrough data page... Can be at www.cvdvaccine.com have a the state of Georgia. Pfizer contra el COVID-19 tienen un riesgo muy de! Of our site each of the availablePfizer-BioNTech COVID-19 Vaccines ; is there wrong.
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