Get Chickenpox Addendum - Texas Department Of State Health Services

This guide provides detailed instructions on how to successfully complete the Chickenpox Addendum form from the Texas Department of State Health Services. By following these steps, users can efficiently complete the form online and ensure accurate submission.

Follow the steps to complete the form online effectively.

1. Click ‘Get Form’ button to obtain the Chickenpox Addendum online and open it for editing.
2. Carefully read through the agreement section. This section includes statements confirming consent for the vaccination, acknowledgment of risks, and permissions granted.
3. Locate the section titled 'Vaccine to be given'. Ensure that 'Chickenpox Vaccine' is listed as the vaccine.
4. Fill in the 'Information about person to receive vaccine' section. Provide the individual’s last name, first name, middle initial, birthdate (in mm/dd/yy format), and sex by circling either M or F.
5. Enter the complete address of the individual receiving the vaccine, including street, city, county, state, and zip code.
6. In the signature section, the person receiving the vaccine or their authorized representative must sign, along with the date of the signature.
7. Complete the Vaccine Administrator section, where the administrator will sign and date the form after the vaccine is administered.
8. Make sure to fill in the site of injection, and record the vaccine manufacturer and lot number for office use.
9. Once all sections are completed, review the form for accuracy. Save changes, and then you can download, print, or share the completed document as needed.

Complete your Chickenpox Addendum online today to ensure your vaccination documentation is processed efficiently.