Form

Smallpox (MVA) vaccination against monkeypox checklist and consent form

Pre-MVA vaccination against monkeypox checklist and consent form.

• From: UK Health Security Agency
• Published: 1 July 2022
• Last updated: 23 August 2022 — See all updates

Applies to England

Documents

Smallpox vaccination against monkeypox checklist

HTML

Smallpox immunisation consent form (open source version)

ODT, 63.9 KB

This file is in an OpenDocument format

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Smallpox immunisation consent form (MS Word version)

MS Word Document, 213 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@ukhsa.gov.uk. Please tell us what format you need. It will help us if you say what assistive technology you use.

Details

Checklist for healthcare professionals when assessing a person for vaccination against monkeypox using the MVA-BN (Modified Vaccinia Ankara – Bavarian Nordic) smallpox vaccine.

The monkeypox vaccination consent form is available in different software versions and is available for download only.

Published 1 July 2022
Last updated 23 August 2022 + show all updates

1. 23 August 2022

   Updated the smallpox vaccination against monkeypox checklist.

2. 1 July 2022

   First published.