As part of your full consent you must ensure the administer of your jab is able to answer ALL the following questions…
Under what authority and instruction is this being sanctioned?
Can you provide the patient info leaflet? (PIL) YES/NO
Is this an experimental treatment? YES/NO
Do you know the contents of the injection? YES/NO
Are there allergens in the shot? YES/NO
Are there any side effects especially in relation to co-existing morbidities & ‘shedding’? YES (list): NO
Has anyone died or suffered serious reactions to the shot? YES (number ……… to date: … /… /…….) NO
Can you explain about the MHRA Yellow Card Scheme? (Govt record of adverse events) YES/NO
Are you aware of the advice from the Specialist pharmacy service “The Green Book” advice on administering the shot to those with allergies to foods and insect stings? YES/NO
Are you a medical professional legally permitted to perform medical procedures on volunteering patients? YES/NO
Do you have anyone present trained in advanced paramedical support for anyone who suffers an anaphylactic reaction to the shot? YES/NO
Do you have oxygen & emergency drugs available? YES/NO
Are you insured in case of injury to me as a result of the injection? YES/NO
Does your insurance cover you for injury to me if something goes wrong? YES/NO
SIGNATURE
PRACTITIONER
IMPORTANT!
Vaccines or any drug can only be administered with full disclosure & your consent.. By LAW!
YOU MUST ASK & GET ANSWERS TO ALL THE ABOVE QUESTIONS…
It is YOUR responsibility to get answers to all these questions BEFORE any substance can be injected.
BY LAW it is the responsibility of the administer to provide answers to all the above questions.
Check the vaccines Code of Practice.
WARNING! Vaccines can change the cellular structure of your physical body, PERMANENTLY!
STAY INFORMED!
STAY SAFE!
Ask these 14 Qs.
ITS THE LAW!