Prevaccination checklist for COVID-19 vaccines

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Prevaccination checklist for COVID-19 vaccines

Multi-Language Public Domain

04/19/2021
By Centers for Disease Control and Prevention (U.S.) ...

File Language:

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Corporate Authors:

Centers for Disease Control and Prevention (U.S.) ; Immunization Action Coalition (Saint Paul, Minn.)
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.

04/19/2021 CS321629-E

pre-vaccination-screening-form.pdf
Subjects:

Communicable Disease Control Coronavirus Infections/prevention & Control COVID-19 Local Government Pandemics Public Health Public Health Practice
Document Type:

Pamphlet (or booklet)
Genre:

Forms
Pages in Document:

7 numbered pages
Collection(s):

Stephen B. Thacker CDC Library
Main Document Checksum:

urn:sha256:ff7d6108af109831d3336fad461c452664438cf9b49fd2ef810f787799b513ab
Download URL:

https://stacks.cdc.gov/view/cdc/105334/cdc_105334_DS1.pdf
File Type:

[PDF - 237.97 KB ]

File Language:

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