WitrynaImmTrac2 Adult Consent Form (Spanish and English version) 2_2024.pdf ... Sign in Witryna1. I reviewed this consent form and have read and understand the “Fact Sheet for Recipients and Caregivers” about the potential risks and benefits of both the Pfizer Vaccine and the Moderna Vaccine. 2. I have the legal authority to consent to have the child named above vaccinated with the Pfizer Vaccine or the Moderna Vaccine. 3.
Immtrac Registration for Adults Spanish – City of Garland …
WitrynaUse this form to register your child, aged 17 and younger, in ImmTrac2. Birth registrars: DO NOT use this form. See F11-11936 below. F11-13366. Immunization Registry … Witrynato the form that do not have a Spanish translation included in the document. I certify under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. Soy intérprete judicial certificado por el Estado de Washington en el idioma español y domino ese idioma, el cual el acusado entiende. philippine heart center president
IMMUNIZATION REGISTRY (ImmTrac2) Minor Consent Form
WitrynaAdults: complete the form titled Adult Consent Form (F11-13366/English) or (F11-13366A/Spanish). Minors: parents/guardians should complete the form titled Minor … WitrynaUpon completion, please fax or mail form to the DSHS ImmTrac Group or a registered Health-care provider. Questions? (800) 252-9152 • (512) 776-7284 • Fax: (866) 624 … WitrynaDisaster Information Retention Consent Form (Please print clearly) PRIVACY NOTIFICATION: With few exceptions, ... (800) 252-9152 • (512) 776-7284 • Fax: … trumpet advertising new orleans