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CONSENT FOR IMMUNIZATION Patient Name Date of Birth I have been offered a copy of the Vaccine Information Statement(s) (IS) checked below. I have read, had explained to me, and understand the information
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I have read had is a document or statement that certifies that the person has read and understood certain information or content.
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Anyone who is provided with the document or information is required to read and file i have read had.
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To fill out i have read had, one must write their name, date, and sign to certify that they have read the information.
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The information that must be reported on i have read had includes the date of reading, name of the person reading, and a statement of understanding.
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