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Space for the designation of medical provider Patients full name: PEEL or passport series and number:. Statutory representatives full name: ...... Contact details (address and telephone number): COVID-19

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How to fill out covid-19 pre-vaccination medical history

01

Obtain the form from the healthcare provider administering the vaccine.

02

Fill out all demographic information accurately.

03

Answer the screening questions regarding symptoms, exposure, and vaccination history.

04

Provide detailed medical history including any allergies, medications, and medical conditions.

05

Sign and date the form to certify all information is accurate.

Who needs covid-19 pre-vaccination medical history?

01

Anyone who is scheduled to receive the covid-19 vaccine should fill out the pre-vaccination medical history form.

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What is covid-19 pre-vaccination medical history?

Covid-19 pre-vaccination medical history includes information about an individual's health conditions, allergies, and previous vaccinations.

Who is required to file covid-19 pre-vaccination medical history?

Individuals who are planning to receive the covid-19 vaccine are required to file their pre-vaccination medical history.

How to fill out covid-19 pre-vaccination medical history?

Covid-19 pre-vaccination medical history can be filled out online through a secure portal provided by healthcare providers or vaccine administrators.

What is the purpose of covid-19 pre-vaccination medical history?

The purpose of covid-19 pre-vaccination medical history is to ensure that individuals are medically eligible to receive the vaccine and to identify any potential contraindications or risks.

What information must be reported on covid-19 pre-vaccination medical history?

Information such as medical conditions, allergies, previous vaccines, medications, and any history of adverse reactions must be reported on covid-19 pre-vaccination medical history.

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