The COVID-19 vaccine is being provided by"The Center for Pediatric & Adolescent Medicine (CPAM) at NO Cost to the patient. However; where allowable and permitted, CPAM will bill the patient's insurance carrier for their costs associated with the administration of the vaccine.
Read over the Emergency Use Authorization (EUA) attached in the following forms or review by clicking on the following blue hyperlink the FDA Fact Sheet for Recipients and Caregivers (https:// www.fda.gov/media/144414/download). Prior to receiving the COVID-19 vaccine I have had the chance to ask questions that were answered to my satisfaction by phone to 706-868-1906 or in person. I understand the benefits and risks of the vaccine indicated and ask that it be given to me or the person named for whom I am authorized to make this request. My signature acknowledges that I read over the FDA Fact Sheet and I was advised to remain on site for 15 minutes after receiving the vaccine. Those with previous anaphylactic reactions should stay for 30 minutes.