Prevaccination checklist for COVID-19 vaccines

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Prevaccination checklist for COVID-19 vaccines

03/15/2021
By Centers for Disease Control and Prevention (U.S.)

[PDF-201.38 KB]

English

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Details:

Corporate Authors:

Centers for Disease Control and Prevention (U.S.)
Description:

For vaccine recipients:

Patient Name: The following questions will help us determine if there is any reason you should not get the COVID-19 vaccine today.

If you answer “yes” to any question, it does not necessarily mean you should not be vaccinated. It just means additional questions may be asked. If a question is not clear, please ask your healthcare provider to explain it.

03/15/2021 CS321629-E

pre-vaccination-screening-form.pdf
Subjects:

[+]

Checklist Coronavirus Infections/prevention & Control COVID-19 Vaccines COVID-19/prevention & Control Surveys And Questionnaires Vaccination
Document Type:

Pamphlet (or booklet)
Pages in Document:

6 numbered pages
Collection(s):

Stephen B. Thacker CDC Library collection
Main Document Checksum:

[+]

urn:sha256:7c4b901872c5c7afcb3cafe76dfb1596f12d713a92aa5d02bfe5aa799ecbbf44
Download URL:

https://stacks.cdc.gov/view/cdc/104599/cdc_104599_DS1.pdf
File Type:

No Additional Files

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Prevaccination checklist for COVID-19 vaccines

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