接种新冠病毒疫苗免责承诺书

更新时间:2023-06-11 06:34:51 阅读: 评论:0

  《接种新冠病毒疫苗免责承诺书》
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本人______________________________,性别______,出生于_______________动物的尾巴有什么作用日,护照号码(或中国永久居留身份证号)寻作文_________________________。本人已认真阅读新型冠状病毒疫苗接种知情同意书,认同上述文件内容,自愿、自费接种新型冠状病毒灭活疫苗,承诺将向接种现场工作人员如实告知本人的健康状况和接种禁忌等情况。本人已清楚了解疫苗的品种、作用、禁忌以及接种疫苗可能导致的不良反应,对选择接种疫苗引起的一切风险完全由本人自行承担。
本人姓名(泰迪配种印刷体安的成语)              小米解锁官网本人签名:
日期:____年______
………………………………………………………………………………………………………
Letter of Commitment on Receiving
Inactivated SARS-CoV-2 Vaccine(Vero Cell)
巨的笔画顺序
I______________(Name),___________(Gender),born on_________(year-month-date) The number of my passport (or Foreign permanent resident ID card)is_______________.I have read letter of connt.I acknowledge the content of the abovementioned documents, connt to voluntary vaccination and will pay for all relevant expens. I promi to truthfully inform health workers on site of my personal information such as health conditions and vaccine contraindications. I am fully aware of the type, usage of the vaccine and its contraindications, as well as the possible adver reactions after vaccination. All risks associated with vaccination shall be borne entirely by mylf.
Name (in print):                      Signature:
Date
安全生产评估报告Date:______ (Day)______(Month)2022
Unofficial translation, for reference only
In ca of discrepancies, the Chine version shall prevail

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标签:接种   疫苗   作用   禁忌   认同   同意书
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