COVID-19 Vaccine Consent Process

The pandemic has been extremely stressful for our residents, caregivers, and staff. StoneGate Senior Living is excited to announce the selection of Walgreens to serve as our healthcare partner in administering the Pfizer-BioNTech COVID-19 vaccine. Trained Walgreens pharmacists and immunization technicians will be doing the injections onsite at each of our supported properties and at no cost to the recipient.

Trained Walgreens pharmacists and immunizing technicians will be doing the injections onsite at each our support properties and at no cost to the recipient.

As a standard procedure, individual consent must be given before every vaccination. However, on the behalf of patients with dementia and other cognitive challenges, family caregiver consent forms are now available for download and from the front desk at each facility during normal business hours.

And while we do not yet have the vaccine, we do need to be prepared for when we do receive it. We ask that all caregiver consent forms be returned to their respective facility as soon as possible. Please review each supported properties’ website for additional details.  We anticipate being able to begin the resident vaccinations the week of December 28, 2020.

The CDC and a preponderance of physicians and scientists are strongly recommending that all Americans, particularly those considered high risk, take the vaccine as it is an important tool in stopping the spread of COVID-19.

If you have any questions or concerns, please do not hesitate to contact us.

COVID-19 Vaccine Consent FAQ

No. The Pfizer-BioNTech COVID-19 Vaccine does not contain SARS-CoV-2 and cannot give you COVID-19.

When a person receives this vaccine, their body produces copies of the spike protein, which does not cause disease, but triggers the immune system to react defensively, producing an immune response against SARS-CoV-2. The vaccine will be given as a series of two injections into a muscle. The second dose given three weeks later.

Trained Walgreens pharmacists and immunizing technicians will be doing the injections onsite and at no cost to the recipient.

It is your choice to permit or to not permit the incapacitated resident to receive the Pfizer-BioNTech COVID-19 Vaccine. It will not change their standard medical care.

If a person with dementia is able to make the decision for themselves, they can choose whether to have the vaccine or not. They just need to give informed consent to do so – the same as for any medical procedure. That decision is theirs to make and will be respected.

Source: The Centers for Disease Control & Prevention

Image: COVID Vaccine Consent

Informed Consent Form Instructions

Caregivers, please complete following sections of the consent form:

  • Section A-1 (Demographics)
  • Section A-2 (Consent)
  • Section B-1 (Screening Questions)
  • Section B-2 (Name & Date)
  • Section C (Insurance — if applicable)

Please leave sections D through F blank. Healthcare personnel will complete these sections prior to administering the vaccination.

Additional Resources

    • What to Expect — we understand that some may feel hesitant about getting the novel COVID-19 vaccine. This handout provides additional information about the vaccine and the process.