COVID-19 Vaccine Informed Consent (General) - DIGITAL FORM
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UPDATED SEPTEMBER 2023
The Briggs COVID-19 Vaccine Informed Consent provides the resident/client/employee/volunteer/general population 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 |
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*This digital form is delivered as a form-fillable PDF and includes 1-year of updates. To receive your electronic file and updates you must complete and return a content license agreement and provide an end-user email address and contact name for file delivery (please allow 2-3 business days for order fulfillment). After 1- year, your update subscription will automatically renew.