Get Multi Vaccine Addendum - Dshs Texas

Filling out the Multi Vaccine Addendum is essential for consenting to vaccines for your loved one. This guide will provide you with clear, step-by-step instructions to help ensure that the process is smooth and straightforward.

Follow the steps to complete the form online easily.

1. Press the ‘Get Form’ button to access the Multi Vaccine Addendum form and open it in your document editor.
2. Begin by providing your agreement for the individual named in the form to receive the vaccines listed below the consent section. Ensure that you read this section thoroughly.
3. Next, confirm that you have received or been offered the Vaccine Information Statement (VIS) for the vaccines you are consenting to by checking the appropriate box.
4. Acknowledge the risks associated with the diseases that the vaccines prevent by ensuring your understanding is clearly stated.
5. Carefully review and confirm your understanding of the benefits and risks of the vaccines listed.
6. Take the opportunity to ask questions regarding the diseases, vaccines, and administration process if needed, ensuring that you clearly state your inquiries.
7. In the section requesting personal information, enter the details for the individual receiving the vaccine: their last name, first name, middle initial, birthdate, sex, city, address, county, state, and zip code.
8. Sign the form in the designated area, confirming that you are the authorized person to consent for the individual named.
9. For clinic or office use, ensure that the relevant personnel fill out details including the clinic address, vaccine given, date administered, vaccine manufacturer, lot number, site of administration, and the signatures of both the vaccine administrator and their title.
10. Finally, review all entered information for accuracy, save your changes, and prepare to download, print, or share the filled-out form as needed.

Complete your documents online with confidence and ease.