Form

COVID-19 vaccination: consent forms and letters for care home residents

Coronavirus (COVID-19) vaccination consent forms and letter templates for care home residents.

• From: Public Health England
• Published: 7 December 2020
• Last updated: 17 December 2020 — See all updates

Documents

COVID-19 vaccination consent form for care home residents who are able to consent (PDF version)

Ref: PHE gateway number 2020365

PDF, 52.1 KB, 1 page

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COVID-19 vaccination consent form for care home residents who are able to consent (open source version)

ODT, 27.1 KB

This file is in an OpenDocument format

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COVID-19 vaccination consent form for care home residents who are able to consent (MS Word version)

MS Word Document, 134 KB

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COVID-19 vaccination consent form letter for care home residents who are able to consent (open source version)

ODT, 22.1 KB

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COVID-19 vaccination consent form letter for care home residents who are able to consent (MS Word version)

MS Word Document, 35.3 KB

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COVID-19 vaccination consent form for care home residents – attorney of a care home resident (PDF version)

Ref: PHE gateway number 2020367

PDF, 52.3 KB, 1 page

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COVID-19 vaccination consent form for care home residents – attorney of a care home resident (open source version)

ODT, 27.7 KB

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COVID-19 vaccination consent form for care home residents – attorney of a care home resident (MS Word version)

MS Word Document, 134 KB

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COVID-19 vaccination consent form letter for care home residents – attorney of a care home resident (open source version)

ODT, 22.6 KB

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COVID-19 vaccination consent form letter for care home residents – attorney of a care home resident (MS Word version)

MS Word Document, 37.2 KB

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COVID-19 vaccination relative’s view form for a care home resident (PDF version)

Ref: PHE gateway number 2020368

PDF, 52.6 KB, 1 page

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COVID-19 vaccination relative’s view form for a care home resident (open source version)

ODT, 28.3 KB

This file is in an OpenDocument format

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COVID-19 vaccination relative’s view form for a care home resident (MS Word version)

MS Word Document, 136 KB

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COVID-19 vaccination relative’s view form letter for a care home resident (open source version)

ODT, 23 KB

This file is in an OpenDocument format

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COVID-19 vaccination relative’s view form letter for a care home resident (MS Word version)

MS Word Document, 36.3 KB

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Details

When considering a decision made in someone’s best interests, the past views of the person should be taken into account. These could be obtained from family, friends, carers or anyone else who has an interest in the welfare of the person, including their GP or other paid health or social care workers. The COVID-19 vaccination relative’s view form for a care home resident can be used by someone acting in the best interests of the person.

Further information on consent and best interest decisions are available in the guidance for healthcare practitioners and in the COVID-19 vaccination training slide set.

The COVID-19 vaccination consent form letter templates are available in different software versions and can be downloaded and adapted to suit the needs of local healthcare teams.

Copies of the forms above are available to order:

• consent form for care home residents (able to consent) – product code COV2020365
• consent form for the attorney of a care home resident – product code COV2020367
• relative’s review form for the relatives of a care home resident – product code COV2020368

Health publications orderline

Immunisation Publications
UK Health Security Agency, 61 Colindale Avenue, Colindale
London
NW9 5EQ

Contact form https://www.healthpubl...

Telephone: 0300 123 1002

Copies of printed publications and the full range of digital resources to support the immunisation programmes can now be ordered and downloaded online. Log in to register and place your order.

Published 7 December 2020
Last updated 17 December 2020 + show all updates

1. 17 December 2020

   Added open source versions and 'best interest' information on holding page.

2. 7 December 2020

   Added revised relative consent form.

3. 7 December 2020

   First published.