Pneumococcal Vaccine Informed Consent
Use this form to document that:
| • | the pneumococcal vaccine was offered to the patient/resident |
| • | the required education about the vaccine was provided to the patient/resident (or their representative) |
| • | the patient/resident (or their representative) consented to or declined the vaccine |
Size: 8 ½" x 11"
Print: 2 sides, black ink
Punching: 5 holes top and side
Packaging: 100 per pad