COVID-19 Vaccine Informed Consent - Resident/Client
UPDATED SEPTEMBER 2023
The Briggs COVID-19 Vaccine Informed Consent provides the resident/client/representative information regarding the 2023-2024 formula for the COVID-19 vaccine, the COVID-19 illness and is used to document consent or declination of the COVID-19 vaccine. It includes information regarding:
• | Brief discussion of how the coronavirus is spread |
• | Clinical symptoms of COVID-19 illness |
• | Populations that should receive the updated 2023-2024 COVID-19 vaccine |
• | Who should not receive or wait for the vaccine |
• | Clinical side effects of the vaccine |
• | Two (2) vaccines are included in this informed consent: Pfizer-BioNTech and Moderna are the vaccines approved for the 2023-2024 season. Links to the current Fact Sheets for each are included as part of obtaining informed consent |
• | Option to sign for the consent of the specific vaccine to be given, by resident/client or their representative |
• | Option to decline the vaccine, by resident/client or their representative |
• | Witness signature/title |
Paper: White
Print: Black ink; 2-sides different
Punching: 5-holes top and side
Packaging: 100 per pad