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Or (c) legally authorized to consent for vaccination for the patient named above. (b) the legal guardian of the patient and confirm that the patient is at least 12 years of age (for pfizer vaccine consent only);


Florida Teens 16 Can Get Pfizer Vaccine Starting Monday Must Fill Out This Form Firstcoastnewscom

Identification (e.g., health card number) sex:

Covid-19 vaccine screening and consent form florida. Least 16 years of age; The moderna and janssen (johnson and johnson) vaccines are authorized for persons age 18 and up. • i understand that this product has not been approved or licensed by fda, but has been authorized for emergency use by fda, under an eua to

The moderna and janssen (johnson and johnson) vaccines are authorized for persons age 18 and up. Below you will find the moderna vaccine screening and consent forms: (b) the parent or legal guardian of the patient and confirm that the patient is at least 16 years of age;

Immunizations forms (including clients receiving rabies vaccine): Information about you (please print) name: (a) the patient and at least 18 years of age;

(b) the legal guardian of the patient and confirm that the patient is at least 12 years of age (for pfizer vaccine consent only); Primary care clinician (family physician or nurse practitioner) home phone. Month day year mobile phone number (patient or guardian):

To download a copy of the form, click here. Further, i hereby give my Information about you (please print) name:

The pfizer vaccine is authorized for persons age 12 and up. Put immunizations in the subject line. (a) the patient and at least 18 years of age;

Or (c) authorized to consent for vaccination for the patient named above. Or (c) authorized to consent for vaccination for the patient named above. Information about you (please print) name:

Hoja informativa para la vacuna pfizer. Florida department of health in alachua county. Below you will find the moderna vaccine screening and consent forms:

Information about you (please print) last name. The letter templates can be. (a) the patient and at least 18 years of age;

Or (c) legally authorized to consent for vaccination for the patient named above. Submit your request directly to florida shots: Information about patient (please print)


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