Preliminary Vaccination Application by Teacher Andrew
1) Have you ever had the Coronavirus vaccine?
2) Do you live at the same address as the label?
3) Do you understand the side effects?
4) Are you in a priority group?
A medical worker
An elderly facility, and so on.
Are you currently sick? (sick name)
5) Have you been diagnosed with any illnesses?
6) If you said “yes” to #5, did your doctor approve you getting the vaccine?
7) Have you been sick or had a fever in the last month?
8) Do you have any other illnesses or conditions?
9) Have you ever had seizures?
10) Do you have any allergies or adverse reactions to foods or medicines?
11) Have you ever felt strange or bad after getting vaccinated?
12) Are you pregnant or bread-feeding?
13) Have you had any other vaccines in the past 2 weeks?
14) Do you have any questions about the vaccine?
15) Don’t write anything here—it is for the doctor to fill out.
16) Do you want to have this vaccine?
17) You don’t need to write anything here.