fbpx COVID-19 Vaccine Consent Process - Adora Midtown
COVID-19 Vaccine Consent Process - Adora Midtown

The pandemic has been extremely stressful for our residents, caregivers, and staff. Adora Midtown Park 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 and at no cost to the recipient.

We are working hard to protect our residents and staff as we continue to fight this pandemic – and soon, we’ll take a huge step forward with onsite COVID-19 vaccines.

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 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 us as soon as possible by U.S. Mail or hand delivered to the front desk. You may also fax it to: 214-765-3333, or send it by email to: Administrator@adoramidtown.com & DON@adoramidtown.com. 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.

Informed Consent Form Instructions

Click here for the COVID-19 Vaccine Consent Form and complete following sections:

  • 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.

Image: Adora Midtown Park COVID Vaccine

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.
Contact Us

8130 Meadow Rd Dallas, TX 75231
Telephone: 214-765-3300

Administrator: John H. Berg
Email administrator@adoramidtown.com
Please, no soliciting.

Compliance Concerns: 877-399-5556 — 24/7/365, anonymous and confidential.

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