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Administration Facility Name/Facility ID: Okeechobee/CHD47COVID19 VACCINE SCREENING AND CONSENT FORM Moderna COVID-19 VaccineSECTION 1: INFORMATION ABOUT YOU (PLEASE PRINT)Name: Last: Date of Birth:
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How to fill out moderna vaccine screening ampamp

01
Make sure to have all the necessary information and documents ready, such as your identification and insurance card.
02
Visit the vaccination center or clinic designated for administering the Moderna vaccine screening.
03
Follow the instructions provided by the healthcare staff on-site.
04
Complete any required forms or questionnaires accurately and honestly.
05
Answer all the screening questions related to your medical history, allergies, and previous vaccinations.
06
Provide any additional information or updates relevant to your health status or conditions.
07
Wait for the healthcare staff to review your screening form and provide further instructions.
08
If eligible, proceed with the Moderna vaccine administration process as advised by the healthcare professionals.

Who needs moderna vaccine screening ampamp?

01
Individuals who meet the eligibility criteria set by the health authorities or the vaccination center.
02
People who require the Moderna vaccine due to their occupation or specific medical conditions.
03
Those who have not received the Moderna vaccine before or need a booster shot as recommended.
04
Individuals who were advised by their healthcare provider to undergo the Moderna vaccine screening.
05
Minors or individuals under the age limit established for the Moderna vaccine.
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The Moderna vaccine screening is a process designed to evaluate individuals for their eligibility and safety prior to receiving the Moderna COVID-19 vaccine.
Individuals seeking to receive the Moderna vaccine may be required to complete a screening form to assess their health status and any potential contraindications.
To fill out the Moderna vaccine screening, individuals should provide accurate information regarding their medical history, current health status, and any allergies or previous vaccine reactions, usually through a provided online form or paper questionnaire.
The purpose of Moderna vaccine screening is to ensure that individuals are eligible to receive the vaccine and to minimize the risk of adverse reactions.
Individuals must report personal information such as name, age, medical history, current medications, allergies, and any previous vaccine reactions.
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