COVID-19 mRNA Vaccine BNT162b2 Pfizer/BioNTech Vaccine National Protocol

This protocol is for the supply and administration of COVID-19 mRNA Vaccine BNT162b2 Pfizer/BioNTech to individuals in accordance with the national COVID-19 vaccination programme.


Annex B: Practitioner authorisation sheet

COVID-19 mRNA Vaccine BNT162b2 Pfizer/BioNTech Vaccine Protocol v00.01

Valid from: DDDDDD Expiry: DDDDDD

Before signing this Protocol, check that the document has had the necessary authorisations in section 1 and 2. Without these, this Protocol is not lawfully valid.

Practitioner

By signing this Protocol you are indicating that you agree to its contents and that you will work within it.

Protocols do not remove inherent professional obligations or accountability.

It is the responsibility of each practitioner to practise only within the bounds of their own competence and any appropriate professional code of conduct.

Template example

Person authorising on behalf of Provider

Template example

Note to person authorising on behalf of Provider

Score through unused rows in the list of practitioners to prevent practitioner additions post managerial authorisation.

This authorisation sheet should be retained to serve as a record of those practitioners authorised to work under this Protocol.

Contact

Email: Covid19VaccinePolicyMailbox@gov.scot

Back to top