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CoronaZentrum her University Rich Test UND ReferenzImpfzentrum Canton Rich Hirschengraben 84 CH8001 Rich coronazentrum@ebpi.uzh.ch Tel: 044/634 60 00 www.coronazentrum.uzh.chPatient Intake Form for
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Start by downloading the patient-intake-form-covid19-vaccine-en from the official website or healthcare provider.
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Gather all necessary personal information such as full name, date of birth, address, and contact details.
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Fill in the medical history section, providing details about any pre-existing conditions, allergies, or medications currently being taken.
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Provide information about COVID-19 vaccination history, including dates, doses received, and any side effects experienced.
05
Answer the questions related to COVID-19 symptoms, exposure to the virus, and recent travel history.
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Any individual who is scheduled or planning to receive the COVID-19 vaccine needs to fill out the patient-intake-form-covid19-vaccine-en. This includes individuals of all ages who are eligible for vaccination as per the guidelines provided by health authorities.
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It is a form used to collect information from patients receiving the COVID-19 vaccine.
Healthcare providers administering the COVID-19 vaccine are required to have patients fill out this form.
Patients can fill out the form by providing personal information, medical history, and consent for receiving the COVID-19 vaccine.
The purpose of the form is to gather necessary information from patients before administering the COVID-19 vaccine.
The form may include personal details, contact information, medical history, allergies, current medications, and consent for the COVID-19 vaccine.
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