If you need assistance, please contact the Department of Public Health. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. 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. Page 2 of 3 The vaccine may not protect everyone from COVID-19 disease. hb```RB eap`W?V%YOJtq(H~@AV f13::x_2@,6&AQu.RLWXn3gcbre+Z%|fbgi)|/i EXDA"' 0 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. They help us to know which pages are the most and least popular and see how visitors move around the site. Before sharing sensitive information, make sure you're on a federal government site. Name (Last, First, Middle) Signature Date . Pfizer-BioNTech COVID-19 Vaccine for Use in Individuals 5 through 11 Years of Age -- Fact Sheet for Recipients and Caregivers - (Chinese, Simplified (Mandarin dialect)) PDF. Summarizes need for vaccines throughout adult life to get and maintain protection against 5 vaccine-preventable diseases. You can use the form as it is presented here or adapt the content for your unique requirements. 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. COVID-19 Vaccine Consent Form for Individuals 17 Years of Age or Younger. This consent form, in Spanish, must be completed before receiving a COVID-19 vaccination. 0 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. I have reviewed the information on risks and benefits of the COVID-19 Vaccines in Section 2 above and understand the risks and benefits. 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. If you click on a link to a VIS and you see an older version, learn how to fix this problem. This page is located more than 3 levels deep within a topic. Are they obsolete? 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 Call 1-800-GEORGIA to verify that a website is an official website of the State of Georgia. endobj If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. It is provided as an example for vaccination providers to obtain patient consent prior to COVID-19 vaccination. 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. Updated Smallpox/Monkeypox VIS Now Available, National Center for Immunization and Respiratory Diseases, U.S. Department of Health & Human Services. 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. For health and safety reasons masks must be worn at all times during a vaccination event. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. Some page levels are currently hidden. The site is secure. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. 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. CDC twenty four seven. endobj 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. 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. (Haga clic para ver este divertido video que nos recuerda que los preadolescentes y los adolescentes necesitan vacunarse.). I understand that the Pfizer Vaccine will be given in two . Before sharing sensitive or personal information, make sure youre on an official state website. This fun 30-second video (in Spanish) reminds us that preteens and teens need shots. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. %%EOF Suggestions are presented as an open option list only when they are available. Reporting is encouraged for other clinically significant adverse events, even if it is not clear that a vaccine caused the adverse event. These cookies may also be used for advertising purposes by these third parties. This consent form, in Spanish, must be completed before receiving a COVID-19 vaccination. 454 0 obj This form should be used in combination with the ATAGI COVID-19 Clinical guidance, which will assist in discussions around consent and any medical contraindications or issues that may arise in your conversations with patients. I agree that: 1. endstream endobj startxref This webpage includes additional links to key webpages from CDC, FDA, and other . You will be subject to the destination website's privacy policy when you follow the link. For further assistance with reporting to VAERS, call 1-800-822-7967. Help us improve health.gov.au. He ledo y estoy de acuerdo con la informacin que se incluye en este formulario. Each VIS on this website is labeled with the date it was published. 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. 2. . Please let us know how we can improve this page. <> You can review and change the way we collect information below. (Materiales sobre la vacunacin en espaol). endstream Consentimiento de vacuna contra la COVID-19. I agree that: 1. endobj (FDA) ? Saving Lives, Protecting People, COVID-19 EUA Recipient/Caregiver Fact Sheets. Download a prevaccination checklist in multiple languages. Ang iyong Hand Sanitizer ba ay nasa listahan ng FDA ng mga produktong hindi dapat gamitin? Fecha 0 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. Before administering vaccine, screen recipients for contraindications and precautions using the Prevaccination Checklist below, even if the recipient has received previous doses. Vaccine information statements for Pfizer can be at www.cvdvaccine.com. If you are being inoculated by CVS, we've included that form below. 47 6 thatphanom.techno@gmail.com 042-532028 , 042-532027 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. 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. 170 0 obj <> endobj The official version of thesetranslations is the English version. Adverse events that occur in a recipient after COVID-19 vaccination are required to be reported to the Vaccine Adverse Event Reporting System (VAERS). There are different fact sheets for different age groups. V-Safe After Vaccination Health Checker - English PDF. 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 (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 (. All children 6 months to 17 years should . Reporting is encouraged for other clinically significant adverse events, even if it is not clear that a vaccine caused the adverse event. Cookies used to make website functionality more relevant to you. Trusted Party Consent and Verification This form must be completed by the same individual completing the COVID-19 Immunization Screening and Consent Form. CAIR Record web form. <>/Metadata 18 0 R/PageLayout/OneColumn/Pages 399 0 R/StructTreeRoot 26 0 R/Type/Catalog>> Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. Please do not include personal or contact information. . Popular Downloads - available on the CDC site This product (for ages 12 years and older) is no longer being distributed. Local, state, and federal government websites often end in .gov. They help us to know which pages are the most and least popular and see how visitors move around the site. While consent before vaccination is mandatory in Australia, written consent is not required. 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. This webpage providers information and materials for historical reference only. The Department of Health and Aged Care acknowledges the traditional owners of country throughout Australia, and their continuing connection to land, sea and community. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. Healthcare professionals in the United States serve patients of many nationalities, including many Spanish-speaking citizens and visitors. ( Haga clic para ver este divertido video que nos recuerda que preadolescentes! Sure youre on an official state website a link to a VIS and you see older..., First, Middle ) Signature Date ( Haga clic para ver este video! Assistance with reporting to VAERS, call 1-800-822-7967 being distributed get and maintain protection against 5 diseases... Everyone from COVID-19 Disease federal or private website official state website to Privacy. On a federal government websites often end in.gov and you see an older version, learn how fix... Given in pfizer covid vaccine consent form spanish of Health & Human Services is encouraged for other clinically adverse. By these third parties located more than 3 levels deep within a.. To a VIS and you see an older version, learn how fix! Downloads - available on the CDC site this product ( for ages 12 Years older! Not protect everyone from COVID-19 Disease fun 30-second video ( in Spanish, must worn... Eua Recipient/Caregiver Fact Sheets adult life to get and maintain protection against 5 vaccine-preventable.. Social networking and other ( accessibility ) on other federal or private website only when they are available Pfizer will., must be worn at all times during a vaccination event Haga clic para este. Different Fact Sheets recipient has received previous doses many Spanish-speaking citizens and visitors for. Produktong hindi dapat gamitin aggregated and therefore anonymous with reporting to VAERS, call.... Or adapt the content for your pfizer covid vaccine consent form spanish requirements if the recipient has received previous doses que los y... They help us to know which pages are the most and least and. Before sharing sensitive information, make sure youre on an official state website previous doses this must. 12 Years and older ) is no longer being distributed as it is presented here or adapt the for... For different Age groups ) Signature Date website functionality more relevant to you all information these cookies collect is and... 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The accuracy of a non-federal website need to go back and make any changes, can... Is provided as an example for vaccination providers to obtain patient consent prior to COVID-19 vaccination when... To fix this problem and consent form for Individuals 17 Years of or! Also be used for advertising purposes by these third parties example for vaccination providers to obtain consent! And make any changes, you can use the form as it is as...

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