Vaccine Consent Form

Create Document

A vaccine consent form is a document used to obtain consent from an individual to administer a vaccine. Health care providers can use the form to gather information about the patient’s present and past health conditions to determine whether the patient is eligible for vaccination.

Vaccine Consent Form

A vaccine consent form is a document used to obtain consent from an individual to administer a vaccine. Health care providers can use the form to gather information about the patient’s present and past health conditions to determine whether the patient is eligible for vaccination.

Create Document
PDF
PDF

Last updated November 21st, 2024

Document Preview

A vaccine consent form is a document used to obtain consent from an individual to administer a vaccine. Health care providers can use the form to gather information about the patient’s present and past health conditions to determine whether the patient is eligible for vaccination.

Downloads: 29
  1. Home »
  2. Consent Forms (34) »
  3. Vaccine

Obtaining Consent

To obtain lawful, valid consent from the patient to receive a vaccine, the following must apply[1]:

  • Full Consent. Individuals must be made aware of and consent to each vaccine they are to receive.
  • Informed. The patient must be informed about the risks of vaccination and what the procedure entails.
  • Information. The patient must be given enough information and advice from vaccine providers to make an informed choice.
  • Duress Free. The individual must give consent without the influence of family or medical professionals.

Vaccine Information Statement (VIS)

The National Vaccine Childhood Injury Act (NCVIA) is a federal law requiring every patient to receive a Vaccine Information Statement (VIS) before receiving certain vaccines.[2] A VIS must be given before each dose in both private and public healthcare settings, regardless of the patient’s age.

Federal law requires that a VIS for the following vaccines:[3]:

  • MMR
  • MNRV
  • Haemophilus influenzae type b (Hib)
  • Diptheria
  • Hepatitis A and B
  • Human Papillomavirus (HPV)
  • Influenza (both inactivated and live)
  • Pertussis-containing vaccines
  • Meningococcal
  • Pneumococcal Conjugate (PCV)
  • Varicella (chickenpox)
  • Rotavirus
  • Polio
  • Tetanus

The Center for Disease Control (CDC) website contains up-to-date English-language VIS information for providers, while its partner Immunize.org provides translated versions.

Sources

    1. National Library of Medicine – Human Vaccines & Immunotherapies
    2. 42 U.S.C. § 300aa-26
    3. Center for Disease Control – About VIS