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COVID-19 VACCINE CONSENT FORM

on 12/23/2020 10:59 AM

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Consent Requirements & Process

 

This has been a very difficult year with the COVID-19 pandemic, but we are pleased to share some good news. The U.S. Food and Drug Administration (FDA) has found a COVID-19 vaccine to be safe and effective, and our facility will be able to give the vaccine to residents. This is very encouraging news.

 

We will begin giving the vaccine to residents at the facility in the next few weeks. We need your consent for the pharmacy to administer the vaccine to your loved one within our facility since they are unable to complete the form themselves. There will be no costs to get the vaccine.

 

We encourage as many residents as possible to get this vaccine. The elderly have a much higher risk for getting very sick, being hospitalized, or dying from COVID-19. The vaccine has been shown to provide a great deal of protection against serious illness due to COVID-19. The more residents that get vaccinated, the better we can protect our community against potential outbreaks and save lives.

 

We will continue to take all necessary precautions after the vaccine is administered, including wearing personal protective equipment and conducting regular testing, to ensure the safety of our residents and staff. We will also work with public health officials to determine how and when to adjust our policies for visitations and social activities and keep you updated.

 

There is a light at the end of the tunnel. We are hopeful that the vaccine will be a lifesaving turning point in the fight against COVID-19. Please do not hesitate to reach out to us with any questions. You may also visit www.cdc.gov/coronavirus/2019-ncov/vaccines to learn more about the vaccine from the CDC or you can review a slide show presentation we prepared that summarizes the data by clicking here

 

Pfizer fact sheet for recipients and caregivers here.

 

 

Filling out Consent Form:

 

  1. You may fill out the form on our website by clicking here.

 

  1. You may come to the facility and fill it out. If the facility is not allowing indoor visitation you will need to call when you are outside the facility and we will bring you the form to sign in the parking lot.

 

  1. Verbal Consent – If you are not able to fill out the form online, and not able to come to the facility you can call the facility and give verbal consent. When you call please let the receptionist know you are calling to give verbal consent for the Covid-19 Vaccine.

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