№ lp_1_2_58318
File format: docx
Character count: 2070
File size: 38 KB
This document is a template form for individuals in healthcare settings to formally decline the COVID-19 vaccine after being provided with necessary information about its benefits and risks.
Year:
2021
Region / City:
United States
Topic:
COVID-19 Vaccine, Healthcare
Document Type:
Template
Organization / Institution:
Healthcare Facility
Author:
Not specified
Target Audience:
Healthcare facility staff, residents, or their representatives
Period of Validity:
Not specified
Approval Date:
Not specified
Date of Modifications:
Not specified
Price: 8 / 10 USD
The file will be delivered to the email address provided at checkout within 12 hours.
The file will be delivered to the email address provided at checkout within 12 hours.
Don’t have cryptocurrency yet?
You can still complete your purchase in a few minutes:- Buy Crypto in a trusted app (Coinbase, Kraken, Cash App or any similar service).
- In the app, tap Send.
- Select network, paste our wallet address.
- Send the exact amount shown above.
The final amount may vary slightly depending on the payment method.
The file will be sent to the email address provided at checkout within 24 hours.
The product description is provided for reference. Actual content and formatting may differ slightly.
Note:
Year
Subject:
Employment / Civil Service
Document Type:
Letter
Agency / Organization:
New York State Department of Civil Service
Target Audience:
Job applicants
Document Type:
Vaccine declination form
Subject:
Hepatitis B vaccination refusal
Related Disease:
Hepatitis B
Related Virus:
Hepatitis B virus (HBV)
Sector:
Occupational health and workplace safety
Intended Signatory:
Employee with occupational exposure to blood or potentially infectious materials
Purpose:
Written confirmation of refusal of hepatitis B vaccination
Cost Statement:
Vaccination offered at no charge to the employee
Risk Acknowledgment:
Continued risk of hepatitis B infection acknowledged by the employee
Future Vaccination Option:
Employee may receive the vaccination series later at no cost
Required Fields:
Employee name and date
Signature Requirement:
Employee signature
Note:
Year
Topic:
Vaccination Consent
Document Type:
Consent Form
Target Audience:
Patients, Healthcare Providers
Year:
2025
Region / city:
England
Topic:
Immunization
Document type:
Patient Group Direction (PGD)
Organization / institution:
UK Health Security Agency (UKHSA)
Author:
Suki Hunjunt, Professor Shamez Ladhani, David Green
Target audience:
Healthcare professionals involved in immunization
Period of validity:
From 5 January 2026 to 5 January 2029
Approval date:
5 January 2026
Amendment date:
2 June 2025, 16 December 2025
Description:
A document detailing the administration guidelines for the pneumococcal polysaccharide conjugate vaccine (PCV13, PCV15) for children under 2 years old in the UK.
Year:
2025
Region / City:
London
Topic:
Neonatal BCG vaccination program
Document Type:
Protocol
Organization / Institution:
NHSE
Author:
Alice Waters
Target Audience:
Healthcare professionals involved in neonatal care and immunization
Period of validity:
Not specified
Approval Date:
Not specified
Date of changes:
September 2025
Year:
2023
Region / City:
N/A
Subject:
Vaccination
Document Type:
Medical Guidelines
Organization / Institution:
Merck
Author:
N/A
Target Audience:
Healthcare professionals
Effective Period:
N/A
Approval Date:
07/13/2015
Revision Dates:
07/13/2015, 11/15/2015, 06/2016, 04/2023, 08/2024
Year:
2025
Region / city:
United Kingdom
Subject:
COVID-19 vaccination
Document type:
Protocol
Institution:
UK Health Security Agency (UKHSA)
Author:
UK Health Security Agency (UKHSA)
Target audience:
Healthcare providers involved in COVID-19 vaccination
Period of validity:
1 October 2025 – 31 January 2026
Approval date:
12 September 2025
Note:
Revision history
Year:
2025
Region / city:
[insert local health board name]
Theme:
Vaccination
Document type:
Patient Group Direction (PGD)
Authorising organisation:
NHS Wales
Target audience:
Healthcare professionals (Registered)
Period of validity:
01 September 2025 - 31 March 2026
Approval date:
07 August 2025
Amendment date:
30 June 2025
Review date:
01 July 2026
Expiry date:
31 March 2026
Year:
2025
Region / city:
England
Topic:
Influenza immunisation
Document type:
Patient Group Direction (PGD)
Organisation:
UK Health Security Agency (UKHSA)
Author:
Christina Wilson, Jamie Lopez-Bernal, Greta Hayward
Target audience:
Healthcare practitioners, NHS organisations
Period of validity:
From 1 September 2025 to 1 April 2026
Approval date:
3 July 2025
Revision history:
Updated annually, latest update 9 July 2025
Reference no:
HPV (GBMSM) PGD
Version no:
v5.0
Valid from:
1 September 2025
Review date:
1 April 2028
Expiry date:
1 September 2028
Author:
Suki Hunjunt, Sharif Ismail, David Green
Region / city:
England
Target audience:
Healthcare practitioners administering HPV vaccine to GBMSM
Type of document:
Patient Group Direction
Organisation:
UK Health Security Agency (UKHSA)
Date of approval:
17 July 2025
Date of modifications:
16 July 2025
Context:
A formal Patient Group Direction for the administration of HPV vaccine to GBMSM, detailing legal, clinical, and procedural requirements for healthcare practitioners in England.
Reference no:
Hib/MenC PGD
Version no:
v6.0
Valid from:
1 July 2025
Expiry date:
30 April 2026
Authorising organisations:
UK Health Security Agency (UKHSA)
Target audience:
Registered healthcare practitioners
Responsible body:
UKHSA
Note:
Amendment history
v1.0 and v2.0:
See previous versions of this PGD template for details (19 January 2016 to 23 April 2018)
v3.0:
PHE Hib/MenC PGD amended to: include vaccination of individuals for the prevention of secondary cases of meningococcal group C disease (24 April 2018)
v4.0:
PHE Hib/MenC PGD amended to: remove reference to individuals with an underlying medical condition (5 March 2020)
v5.0:
UKHSA Hib/MenC PGD amended to: include minor rewording of standard text, layout and formatting changes (4 May 2022)
v6.0:
UKHSA Hib/MenC PGD amended to: include minor rewording, updated references, and changes to the childhood immunisation schedule (2 June 2025)
Developed by:
Christina Wilson (Lead Pharmacist), Professor Shamez Ladhani (Paediatric Infectious Diseases Consultant), David Green (Nurse Consultant for Immunisation Programmes)
Peer-reviewed by:
UKHSA Immunisations PGD Expert Panel
Date approved:
2 June 2025
Year:
2025
Region / city:
Global
Topic:
Vaccine Policy, Maternal Health, Group B Streptococcus
Document type:
WHO Guidance
Institution:
World Health Organization (WHO)
Author:
WHO ECVP
Target audience:
Policymakers, Vaccine Developers, Public Health Authorities
Period of validity:
Ongoing
Approval date:
March 11, 2025
Date of changes:
Not specified
Year:
2025
Region:
England
Subject:
Hepatitis B vaccination for renal patients
Document Type:
Patient Group Direction (PGD)
Authorising Organisation:
UK Health Security Agency (UKHSA)
Target Audience:
Registered healthcare professionals
Period of Validity:
28 February 2025 - 28 February 2028
Approval Date:
28 February 2025
Amendment Date:
21 February 2025
Year:
2024
Region / city:
England
Topic:
Vaccination
Document type:
Patient Group Direction
Organization:
UK Health Security Agency (UKHSA)
Author:
Christina Wilson, Dr. Mary Ramsay, David Green
Target audience:
Registered healthcare practitioners
Period of validity:
10 October 2024 - 30 April 2027
Approval date:
4 October 2024
Amendments date:
9 October 2024
Year:
2018
Region / City:
Oregon
Theme:
Vaccine Replacement, Immunization Policy
Document Type:
Policy
Organization:
Oregon Immunization Program (OIP)
Target Audience:
VFC program organizations, Healthcare providers
Period of Action:
Ongoing
Approval Date:
Not specified
Amendment Date:
Not specified
Document type:
Regulatory template appendix
Subject:
Quality information summary for finished pharmaceutical products and vaccines
Procedure:
Reference SRA collaborative procedure
Regulatory framework:
WHO Guidelines on submission of documentation for prequalification
Issuing organization:
World Health Organization
Series:
WHO Technical Report Series
Series number:
No. 1010
Year:
2018
Scope:
Pharmaceutical products and vaccines approved by stringent regulatory authorities
Intended use:
National registration under the SRA collaborative procedure
Confidentiality status:
Includes confidential quality information
Approval basis:
Information as approved by the reference SRA
Change management:
Revision required upon approved variations affecting QIS-SRA (crp)
Year:
2021
Region / City:
United States
Topic:
COVID-19 Vaccine, Long Term Care, Health and Safety Regulations
Document Type:
Guide
Organization:
Centers for Medicare & Medicaid Services (CMS), Centers for Disease Control and Prevention (CDC)
Author:
Centers for Medicare & Medicaid Services (CMS), Centers for Disease Control and Prevention (CDC)
Target Audience:
Long Term Care Facility Leaders, Healthcare Providers, Staff
Period of Action:
2021
Approval Date:
November 2021
Date of Last Revision:
October 26, 2022
Year:
2021
Country:
Global
Topic:
COVID-19 vaccination during pregnancy
Document Type:
Supplementary material
Study Type:
Systematic review
Authors:
Not specified
Target Audience:
Researchers, healthcare professionals, policy makers
Period of validity:
Not specified
Approval Date:
Not specified
Date of Changes:
Not specified
Year:
2020
Region / city:
United Kingdom
Topic:
Undergraduate medical education, COVID-19, e-learning
Document type:
Report
Organization / institution:
University of Birmingham, Clinical Skills Department
Author:
Melissa Jayne Whiles
Target audience:
Medical students, clinical teaching fellows, education and training departments
Period of validity:
2020
Date of approval:
July 4th, 2020
Date of changes:
N/A