Pre-event screening worksheet for smallpox vaccine
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Pre-event screening worksheet for smallpox vaccine

Filetype[PDF-272.95 KB]

  • English

  • Details:

    • Description:
      You have received a smallpox Vaccine Information Statement ("VIS"̂) called ìSmallpox Vaccine: What You Need to Know.î The VIS contains important information about smallpox vaccination. The VIS describes people who should not get the smallpox vaccine or should wait to get the vaccine because of their own health or the health of their "̀close contacts." "Close contact"̂ means a person who you live with. It also means a person you have close physical contact with, such as a sex partner or someone you share a bed with. Friends or people you work with are not "̀close contacts.")

      Please read the VIS very carefully and then answer the questions in this worksheet. The VIS and the questions in this worksheet will help you decide if you should or should not get the smallpox vaccine. Answer each question the best you can. Some questions in this worksheet are very personal. You should not put your name on this worksheet. The worksheet is for you to keep. The staff at the smallpox vaccination clinic will not ask for or collect this sheet. If you wish, you may ask clinic staff questions concerning this sheet.

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