Get Pneumococcal Conjugate Addendum - Texas Department Of State ... - Dshs Texas

Filling out the Pneumococcal Conjugate Addendum is an important step in ensuring vaccination compliance. This comprehensive guide will assist you in completing the form accurately and efficiently.

Follow the steps to complete the Pneumococcal Conjugate Addendum online.

1. Use the ‘Get Form’ button to retrieve the Pneumococcal Conjugate Addendum and open it in your document editor.
2. Begin by confirming your consent by checking the box that states you agree the person named below will receive the vaccine indicated. This section is crucial for legal purposes.
3. Review the provided Vaccine Information Statement (VIS) and ensure that you acknowledge receipt of this document, which outlines important details regarding the vaccine.
4. Complete the section that discusses risks and benefits associated with both the disease and the vaccine. This provides essential clarity for informed consent.
5. Fill in details regarding the person receiving the vaccine, including their full name, birthdate, and address. Accurate information is vital for record-keeping purposes.
6. Indicate the sex of the person receiving the vaccine by circling either 'M' for male or 'F' for female.
7. Document relevant vaccine information, such as the date the vaccine is administered, the manufacturer, and the vaccine lot number.
8. Ensure that either the person receiving the vaccine or an authorized individual provides their signature to grant consent for the vaccine administration.
9. After completion, you may save changes, print, or share the form according to your needs.

Complete your documents online today to ensure a smooth vaccination process.