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COVID-19 VACCINE SCREENING AND CONSENT FORM Moderna/Pfizer COVID-19 Vaccine SECTION 1: INFORMATION ABOUT YOU (PLEASE PRINT) Name: Last: First: Middle Initial: Date of Birth: Month: Day: Year: Mobile

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What is covid-19 vaccine consent?

COVID-19 vaccine consent is the official authorization given by an individual to receive a COVID-19 vaccine.

Who is required to file covid-19 vaccine consent?

Individuals who wish to receive a COVID-19 vaccine are required to file COVID-19 vaccine consent.

How to fill out covid-19 vaccine consent?

To fill out COVID-19 vaccine consent, individuals need to provide their personal information, medical history, and any relevant allergies or health conditions.

What is the purpose of covid-19 vaccine consent?

The purpose of COVID-19 vaccine consent is to ensure that individuals understand the risks and benefits of receiving a COVID-19 vaccine and voluntarily agree to be vaccinated.

What information must be reported on covid-19 vaccine consent?

COVID-19 vaccine consent must include the individual's name, date of birth, medical history, allergies, and any other relevant health information.

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