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CONSENT FORM Tetanus-Diphtheria-Pertussis Vaccine (Trap) Student’s last name: First name: Date of Birth: Year Month Day Gender: M F School: Parent/Guardian’s home number: ParenGuardian’s’s

How to fill out vaccine information statementdiphformria-tetanus-pertussisvis

How to fill out the vaccine information statement for diphtheria-tetanus-pertussis (DTaP) vaccine:

1. Start by obtaining the vaccine information statement (VIS) for the DTaP vaccine. It can be provided by your healthcare provider or found on the Centers for Disease Control and Prevention (CDC) website.
2. Read through the VIS carefully to understand the information it provides about the DTaP vaccine. It will include details about the vaccine, its benefits, possible side effects, and any precautions to be aware of.
3. Ensure that you have the necessary information to complete the form. This usually includes the recipient's name, date of birth, and any relevant medical history or allergy information.
4. Fill out the recipient's information accurately in the designated fields on the VIS. Double-check for any spelling or typing errors to ensure the information is correct.
5. Review the consent and signature section of the VIS. If you are filling out the form on behalf of someone else, make sure you have the legal authority to do so. If necessary, obtain the appropriate signatures or consent for vaccination.
6. Provide the completed form to your healthcare provider or the appropriate authority as directed. They will keep a copy for their records and provide you with any necessary paperwork or documentation.

Who needs the vaccine information statement for diphtheria-tetanus-pertussis (DTaP) vaccine?

1. Parents or legal guardians of infants and young children who are due to receive the DTaP vaccine. The VIS is typically provided to ensure that they are informed about the vaccine, its benefits, and potential side effects.
2. Adults and individuals who require the DTaP vaccine, such as healthcare workers, teachers, or individuals planning to travel to areas where diphtheria, tetanus, or pertussis are prevalent.
3. Anyone who requests it. The VIS is a valuable resource for anyone seeking information about the DTaP vaccine, regardless of age or vaccination status. It allows individuals to make informed decisions about their own health or the health of their children.

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