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Each vaccination is preceded by a medical qualification, during which the doctor who qualifies for the vaccination asks a number of questions to rule out contraindications and decide whether to administer or postpone the vaccination. Before visiting the doctor, you should complete the questionnaire, which will help you qualify for vaccination.
- The qualification for vaccination allows for the exclusion of contraindications for taking the preparation
- In the case of the COVID-19 vaccine, before visiting a doctor, we can complete a questionnaire that will facilitate the entire qualification process
- The questionnaire is divided into two parts and consists of 18 questions
- Do you want to live longer? Make a simple test and find out how!
- You can find more up-to-date information on the TvoiLokony home page
Pre-vaccination questionnaire with a list of questions
The National Institute of Hygiene – the National Institute of Public Health released a questionnaire for the initial screening interview before vaccinating an adult against COVID-19. The form to be completed before visiting the doctor consists of 18 questions. The answers provided by the doctor will decide whether the patient is eligible for vaccination, whether there are contraindications, and whether the vaccination should be postponed. The questionnaire is an introduction to the qualification, the doctor may also ask additional questions. If any issues are unclear, doubts can be dispelled during the visit.
See also: What does the COVID-19 vaccination look like? [WE EXPLAIN]
18 questions qualifying for vaccination
The questionnaire consists of two parts. The first one contains the following eight questions:
- Have you had a positive genetic or antigen test for SARS-CoV-4 in the last 2 weeks?
- In the last 14 days, have you had close contact or live with a person who tested positive for SARS-CoV-2 genetic or antigen test or live with a person who had symptoms of COVID-19 during this period (listed in questions 3-5)?
- Have you had an elevated body temperature or fever in the last 14 days?
- In the last 14 days, have you had a new, persistent cough or an increase in chronic cough due to a recognized chronic disease?
- In the last 14 days, have you experienced a loss of sense of smell or taste?
- Have you returned from abroad in the last 14 days (red zone)?
- Have you received any vaccine in the last 14 days?
- Do you have a cold or diarrhea or vomiting today?
Questions can be answered Yes or No. A positive answer to any of the above questions may be the reason for postponing COVID-19 vaccination. The Ministry of Health recommends that you come to the vaccination when we are able to answer all of the above questions in a negative way. If in doubt, please check with your vaccinating doctor.
The second part of the questionnaire consists of 10 questions about general health. Each of them can be answered with: Yes, No or I don’t know. If the answer is Yes or Don’t know, additional explanations are required.
- Do you feel sick today, is there a worsening (exacerbation) of your chronic disease?
- In the past, has your doctor diagnosed you with a severe, generalized allergic reaction (anaphylactic shock) after administration of any medicine or food, or after an insect bite?
- Have you ever had a severe adverse reaction after vaccination?
- Has your doctor ever diagnosed you with an allergy to polyethylene glycol (PEG) or other substances?
- Do you suffer from a disease that significantly reduces immunity (cancer, leukemia, AIDS or other diseases of the immune system)?
- Are you receiving drugs that suppress the immune system (immunosuppressants), e.g. cortisone, prednisone or other corticosteroids (dexamethasone, Encortolone, Encorton, hydrocortisone, Medrol, Metypred, etc.), anti-cancer drugs (cytostatic), drugs taken after organ transplants, radiotherapy (irradiation) or treatment for arthritis, inflammatory bowel disease (e.g. Crohn’s disease) or psoriasis?
- Do you have hemophilia or other serious bleeding disorders? Do you receive anticoagulants?
- (only for women) Are you pregnant?
- (only for women) Do you breastfeed your baby?
- Do you have any doubts about the questions asked? Were any of the questions unclear?
At the end of the questionnaire, there are spaces for the signature of the person completing the form, the signature of the person checking the form, and the declaration of voluntary COVID-19 vaccination. The entire form is available for download HERE
The editorial board recommends:
- The British have already made up their minds. Third COVID-19 mutation booster dose from September
- Can I get vaccinated against COVID-19 after the flu vaccine?
- Who can get vaccinated against COVID-19? CDC Recommendations
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