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

This file may not be suitable for users of assistive technology.

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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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Request an accessible format.

If you use assistive technology (such as a screen reader) and need a version of this document in a more accessible format, please email publications@phe.gov.uk. Please tell us what format you need. It will help us if you say what assistive technology you use.

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

ODT, 22.1 KB

This file is in an OpenDocument format

This file may not be suitable for users of assistive technology.

Request an accessible format.

If you use assistive technology (such as a screen reader) and need a version of this document in a more accessible format, please email publications@phe.gov.uk. Please tell us what format you need. It will help us if you say what assistive technology you use.

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

MS Word Document, 35.3 KB

This file may not be suitable for users of assistive technology.

Request an accessible format.

If you use assistive technology (such as a screen reader) and need a version of this document in a more accessible format, please email publications@phe.gov.uk. Please tell us what format you need. It will help us if you say what assistive technology you use.

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

This file may not be suitable for users of assistive technology.

Request an accessible format.

If you use assistive technology (such as a screen reader) and need a version of this document in a more accessible format, please email publications@phe.gov.uk. Please tell us what format you need. It will help us if you say what assistive technology you use.

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

ODT, 27.7 KB

This file is in an OpenDocument format

This file may not be suitable for users of assistive technology.

Request an accessible format.

If you use assistive technology (such as a screen reader) and need a version of this document in a more accessible format, please email publications@phe.gov.uk. Please tell us what format you need. It will help us if you say what assistive technology you use.

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

MS Word Document, 134 KB

This file may not be suitable for users of assistive technology.

Request an accessible format.

If you use assistive technology (such as a screen reader) and need a version of this document in a more accessible format, please email publications@phe.gov.uk. Please tell us what format you need. It will help us if you say what assistive technology you use.

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

ODT, 22.6 KB

This file is in an OpenDocument format

This file may not be suitable for users of assistive technology.

Request an accessible format.

If you use assistive technology (such as a screen reader) and need a version of this document in a more accessible format, please email publications@phe.gov.uk. Please tell us what format you need. It will help us if you say what assistive technology you use.

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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If you use assistive technology (such as a screen reader) and need a version of this document in a more accessible format, please email publications@phe.gov.uk. Please tell us what format you need. It will help us if you say what assistive technology you use.

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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If you use assistive technology (such as a screen reader) and need a version of this document in a more accessible format, please email publications@phe.gov.uk. Please tell us what format you need. It will help us if you say what assistive technology you use.

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

This file may not be suitable for users of assistive technology.

Request an accessible format.

If you use assistive technology (such as a screen reader) and need a version of this document in a more accessible format, please email publications@phe.gov.uk. Please tell us what format you need. It will help us if you say what assistive technology you use.

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

MS Word Document, 136 KB

This file may not be suitable for users of assistive technology.

Request an accessible format.

If you use assistive technology (such as a screen reader) and need a version of this document in a more accessible format, please email publications@phe.gov.uk. Please tell us what format you need. It will help us if you say what assistive technology you use.

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

This file may not be suitable for users of assistive technology.

Request an accessible format.

If you use assistive technology (such as a screen reader) and need a version of this document in a more accessible format, please email publications@phe.gov.uk. Please tell us what format you need. It will help us if you say what assistive technology you use.

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

MS Word Document, 36.3 KB

This file may not be suitable for users of assistive technology.

Request an accessible format.

If you use assistive technology (such as a screen reader) and need a version of this document in a more accessible format, please email publications@phe.gov.uk. Please tell us what format you need. It will help us if you say what assistive technology you use.

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

Find public health resources

Find this resource on www.gov.uk/publichealthresources where you can view, download or order resources free of charge.

Alternatively, you can get in touch by phone or email.

Please have the product code with you when you contact us.

Email publichealthresources@ukhsa.gov.uk

Contact form https://www.gov.uk/gui...

Telephone: 0300 123 1002

Monday to Friday, 9am to 5:30pm

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.