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    Consent Form (Sinovac)

    Uploaded by

    Kresta Benigno
    This document is an informed consent form for receiving the Sinovac COVID-19 vaccine in the Philippines. It provides information on the vaccine's emergency use authorization, screening process for vaccination, risks and benefits of the vaccine, and consent to be vaccinated. It also allows for information sharing for public health purposes and consent to potential health packages through PhilHealth in case of adverse events. Recipients sign confirming they understand this information and consent to vaccination.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Consent Form (Sinovac)

    Uploaded by

    Kresta Benigno
    96 views1 page
    This document is an informed consent form for receiving the Sinovac COVID-19 vaccine in the Philippines. It provides information on the vaccine's emergency use authorization, screening process for vaccination, risks and benefits of the vaccine, and consent to be vaccinated. It also allows for information sharing for public health purposes and consent to potential health packages through PhilHealth in case of adverse events. Recipients sign confirming they understand this information and consent to vaccination.

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    This document is an informed consent form for receiving the Sinovac COVID-19 vaccine in the Philippines. It provides information on the vaccine's emergency use authorization, screening process for vaccination, risks and benefits of the vaccine, and consent to be vaccinated. It also allows for information sharing for public health purposes and consent to potential health packages through PhilHealth in case of adverse events. Recipients sign confirming they understand this information and consent to vaccination.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    96 views1 page

    Consent Form (Sinovac)

    Uploaded by

    Kresta Benigno
    This document is an informed consent form for receiving the Sinovac COVID-19 vaccine in the Philippines. It provides information on the vaccine's emergency use authorization, screening process for vaccination, risks and benefits of the vaccine, and consent to be vaccinated. It also allows for information sharing for public health purposes and consent to potential health packages through PhilHealth in case of adverse events. Recipients sign confirming they understand this information and consent to vaccination.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    INFORMED CONSENT FORM FOR THE SINOVAC COVID-19 VACCINE

    of the Philippine National COVID-19 Vaccine Deployment and Vaccination Program


    as of April 15, 2021

    Name: Birthdate: Sex:

    Address:

    Occupation: Contact Number:

    Health facility:

    INFORMED CONSENT

    I confirm that I have been provided with adequate I authorize releasing all information needed for
    information about SINOVAC COVID-19 vaccine, its public health purposes including reporting to
    Emergency Use Authorization from the Philippine applicable national vaccine registries, consistent
    Food and Drug Administration with advice for with personal and health information storage
    healthcare workers directly exposed to COVID-19 protocols of the Data Privacy Act of 2012.
    patients and those with comorbidities, and the
    recommendations of the interim National I hereby give my consent to be vaccinated with the
    Immunization Technical Advisory Group (iNITAG) in SINOVAC COVID-19 Vaccine.
    the absence of any other vaccine to provide workers
    in frontline health services the autonomy to decide to
    be vaccinated with this specific batch of SINOVAC
    vaccines without prejudice to immediate eligibility for
    other vaccines. I have received sufficient information
    on the benefits and risks of COVID-19 vaccines and I
    understand the possible risks if I am not vaccinated.

    I confirm that I have been screened for health


    conditions that may merit deferment or special Signature over Date
    precautions during vaccination as indicated in the Printed Name
    Health Screening Questionnaire.

    I was provided an opportunity to ask questions, all of In case eligible individual is unable to sign:
    which were adequately and clearly answered. I, I have witnessed the accurate reading of the
    therefore, voluntarily release the Government of the consent form and liability waiver to the eligible
    Philippines, the vaccine manufacturer, their agents individual; sufficient information was given and
    and employees, as well as the hospital, the medical queries raised were adequately answered. I
    doctors and vaccinators, from all claims relating to
    hereby confirm that he/she has given his/her
    the results of the use and administration of, or the
    consent to be vaccinated with the SINOVAC
    ineffectiveness of the SINOVAC COVID-19 vaccine.
    COVID-19 Vaccine.
    I understand that while most side effects are minor
    and resolve on their own, there is a small risk of
    severe adverse reactions, such as, but not limited to
    allergies, and that should prompt medical attention be
    Signature over Date
    needed, referral to the nearest hospital shall be
    Printed Name
    provided immediately by the Government of the
    Philippines. I have been given contact information for
    follow up for any symptoms I may experience after If you chose not to get vaccinated, please list
    vaccination. down your reason/s:
    I understand that by signing this Form, I have a right
    to health benefit packages under the Philippine Health
    Insurance Corporation (PhilHealth), in case I suffer a
    severe and/or serious adverse event, which is found
    to be associated with the SINOVAC COVID-19 vaccine
    or its administration. I understand that the right to
    claim compensation is subject to the guidelines of the
    PhilHealth.

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