Informed Consent Form for 2023 Varicella Zoster Vaccine Administration
Dear Parent/Guardian,
We are reaching out to inform you about the importance of vaccinating your child against varicella zoster virus, which causes chickenpox and shingles. By providing consent for the administration of the varicella zoster vaccine, you are taking a proactive step in protecting your child from these potentially serious infections.
It is crucial to understand that chickenpox and shingles can lead to complications such as pneumonia, encephalitis, and even long-term nerve damage. By vaccinating your child, you are not only safeguarding their health but also contributing to the prevention of the spread of these diseases within the community.
The varicella zoster vaccine is a safe and effective way to prevent chickenpox and shingles. Like all vaccines, it may cause mild side effects such as redness or swelling at the injection si
te, low-grade fever, or mild rash. These side effects typically resolve on their own and are far less serious than the potential complications of the diseases themselves.
Before consenting to the administration of the varicella zoster vaccine, please ensure that you have discussed any concerns or questions with your healthcare provider. It is important to make an informed decision based on accurate information and expert guidance.
建议尽早带爸妈接种带状疱疹疫苗By signing below, you acknowledge that you have read and understood the information provided in this document and give consent for your child to receive the varicella zoster vaccine. You also confirm that you have had the opportunity to ask questions and receive answers regarding the vaccine.
Thank you for prioritizing your child's health and well-being by considering vaccination against varicella zoster virus. If you have any further questions or require additional information, please do not hesitate to contact us.
Sincerely,
[Your Healthcare Provider's Name]
[Date]
Signature of Parent/Guardian: _______________________
Date: _______________________
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