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Covid-19 Vaccine Screening And Consent Form Cdc. Month day year mobile phone number (patient or guardian): Or (c) legally authorized to consent for vaccination for the patient named above.

Covid 19 Vaccine Screening And Consent Form Cdc googlefeud
Covid 19 Vaccine Screening And Consent Form Cdc googlefeud from www.sleidse.org

Further, i hereby give my consent to the florida department of health (doh) or. (b) the legal guardian of the patient and confirm that the patient is at least 12 years of age (for pfizer vaccine consent only); Cdc is issuing eui to provide information about use of this vaccine as an additional primary dose in certain immunocompromised persons.

Month Day Year Mobile Phone Number (Patient Or Guardian):

Or (c) legally authorized to consent for vaccination for the patient named above. * use of this form is optional. Personal immunization information in florida shots and my personal immunization information will be shared with the centers for disease control (cdc) or other federal agencies.

If You Are Not Vaccinated, Find A Vaccine.

Or (c) legally authorized to consent for vaccination for the patient named above. If you are not vaccinated, find a vaccine. Information about patient (please print) name:

Information About Patient (Please Print)

Covid 19 vaccine screening and consent form cdc. Or (c) legally authorized to consent for vaccination for the patient named above. Information about patient (please print)

Information About You (Please Print) Name:

(b) the legal guardian of the patient and confirm that the patient is at least 12 years of age (for pfizer vaccine consent only); (b) the legal guardian of the patient and confirm that the patient is at least 12 years of age (for pfizer vaccine consent only); Vaxzevria (astrazeneca) , comirnaty (pfizer), spikevax (moderna), or nuvaxovid (novavax).

Information About You (Please Print) Name:

(cdc) cr other federal agencies. Month day year mobile phone number (patient or guardian): Covid19 vaccine screening and consent form cdc how to from kimia20.morriscountypride.org (a) the patient and at least 18 years of age;

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