Pneumococcal Vaccine Informed Consent

Updated 2023

Briggs Pneumococcal Vaccine Informed Consent provides patient/resident information for the currently available pneumococcal vaccinations: polysaccharide (PPSV23) and conjugate (PCV13, PCV15 and PCV20). The form is used to document education and offering the vaccine as well as consent or declination of the pneumococcal vaccines.

(Additional verbiage was added to the populations that should receive the PCV13 vaccine to denote that this form of the vaccine is not routinely recommended for adults age 65 and older.)

Updated to reflect the ACIP (Advisory Committee on Immunization Practices) and CDC recommendations, including information for the provider regarding which populations should receive the vaccine and sequencing of the vaccines, who should not receive the vaccine or should wait, and clinical side effects of the vaccine. The link to each VIS (Vaccine Informed Statement) is provided.

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