COVID-19 Vaccine Screening and Consent Form SCREENING AND CONSENT FORM –COVID-19 Vaccine Version 1.0 – December 30, 2020

Long-Term Care Other
Vaccines Labs, Testing & Screening Other

Summary

  • LTCHs are strongly encouraged to obtain consent as soon as possible and have consent forms completed at least 72 hours in advance of each home’s clinic date.

Actions

  • Form is provided for use indicating consent is a critical component of the vaccine program and must be secured  for vaccines to be given. Forms request specific PHI such as health card number and include screening questions such allergies, immune problems, pregnancy and written consent.

DISCLAIMER: This document has been reviewed by Ontario Health West staff. While staff has provided its summary and interpretation of key action items, every health service provider remains responsible for ensuring their own understanding of the document and actions items, next steps and/or accountabilities outlined in the document.

Past Versions

No Past Versions

DD Mmmmmm 2020 – PASTE TITLE HERE