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New Update: COVID-19 Vaccine Consent Forms
We have updated the GHA Template COVID-19 Vaccine Eligibility and Consent Form to add a question confirming the recipient’s eligibility to receive the vaccine. This update also includes a new page with the current list of groups eligible to receive the COVID-19 vaccine in Georgia. While you do not need to notate the individual criteria that the patients meet within each category, it is recommended that you have patients attest, either in writing or by a digital appointment scheduling questionnaire, that they fit into one of the eligibility categories. As additional information becomes available or as new vaccines receive emergency use authorization or approval from the FDA, the consent form will likely need to continue to be revised.
PLEASE NOTE: There was a misprint in Section 1 of the form that was distributed yesterday.The only change to this version is to correct that error.
The Georgia Department of Public Health now requires COVID-19 vaccine administrators to report the race and ethnicity of vaccine recipients in the Georgia immunization registry known as GRITS. GHA has updated its Template COVID-19 Vaccine Consent Form to include this information. Please note, there is no requirement that you use this template consent form, but you are required to report to GRITS. As additional information becomes available or as new vaccines receive emergency use authorization or approval from the FDA, the consent form will likely need to be revised.
The CDC has published a Pre-Vaccination Checklist for COVID-19 Vaccines. The new Checklist includes a list of screening questions as well as clinical considerations for health care providers when reviewing the screening questions with vaccine recipients. GHA has updated its Template COVID-19 Vaccine Consent Formto include additional screening questions from the CDC Checklist. Please note, there is no requirement that you use this template consent form or that you use the CDC Checklist. Both are being provided as resources only. As additional information becomes available or as new vaccines receive emergency use authorization or approval from the FDA, the consent form will likely need to be revised.
Prior to finalizing either the vaccine consent form or the vaccine refusal acknowledgement form, GHA recommends hospitals review them with their clinical experts, legal counsel and risk managers. These forms are being provided for informational purposes only and are not legal advice. There is no requirement to use the GHA templates, and some facilities have already developed or are working on developing their own forms. As additional vaccines receive emergency use authorization or approval from the FDA, the consent form will likely need to be revised.
If you have questions about the template COVID-19 Vaccine Consent Form or the state’s COVID-19 vaccine distribution plan, please contact COVID19@gha.org.
*The FDA does not require a recipient’s informed consent for the administration of an EUA product like the COVID-19 vaccine. For that reason, this type of form could alternatively be used as a “screening and acknowledgment form” rather than a “consent form.”