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***1st Dose*** INFORMED CONSENT FOR PFIZER IMMUNIZATIONS Name:Date of Birth:Phone Number:Food/Drug Allergies: Race:Sex: Ethnicity:Hispanic or Latino Asian American Indian/Alaska Native Black/African

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How to fill out general immunization informed consent

01

Obtain the general immunization informed consent form from the healthcare provider or facility.

02

Read the form carefully and ensure you understand the information provided.

03

Fill out personal information such as name, date of birth, and contact details.

04

Provide information about any existing medical conditions or allergies.

05

Acknowledge understanding of the risks and benefits of the immunization by signing and dating the form.

06

Keep a copy of the completed form for your records.

Who needs general immunization informed consent?

01

Anyone who is receiving a vaccination or immunization from a healthcare provider or facility.

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What is general immunization informed consent?

General immunization informed consent is a formal process where individuals are provided with information about vaccines before they are administered to make an informed decision about receiving the vaccine.

Who is required to file general immunization informed consent?

Healthcare providers are required to file general immunization informed consent for each individual receiving a vaccine.

How to fill out general immunization informed consent?

General immunization informed consent forms are typically filled out by the individual receiving the vaccine or their legal guardian, providing personal information and indicating consent for vaccination.

What is the purpose of general immunization informed consent?

The purpose of general immunization informed consent is to ensure that individuals are fully informed about the risks and benefits of vaccines before receiving them.

What information must be reported on general immunization informed consent?

General immunization informed consent forms typically include information about the vaccine being administered, potential side effects, and consent for vaccination.

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