Pneumococcal Vaccine Informed Consent - DIGITAL FORM
UPDATED Fall 2024 to include Pneumococcal Conjugate (PCV21) and to reflect the CDC Advisory Committee on Immunization Practices (ACIP) recommendation for lowering the age for pneumococcal vaccination from 65 to 50 years old.
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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 |
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*SUBSCRIPTION: Form access is licensed for 1-year per agency/facility location. Multiple sites require a quote. 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) and provide the facility/agency address. After 1- year, your subscription will automatically renew.
All Briggs Digital on Demand products require a credit card payment (or pre-payment) to receive digital files electronically.
Briggs Healthcare does not allow use of any of its intellectual property without a valid license and payment of fees.