Vaccine Forms
The information below is intended for residents or substitute decision makers who have been contacted by Bethammi Nursing Home or Hogarth Riverview Manor and asked to complete a vaccine consent form for a resident.
Respiratory Syncytial Virus (RSV) Vaccine
Respiratory syncytial virus (RSV) is a common respiratory virus that is a major cause of illness among Ontarians. RSV can cause infection in the upper (e.g., nose and throat) and lower (e.g., lower airways and lungs) parts of a person's respiratory system.
RSV can be passed from one person to another through respiratory droplets (such as from a cough or sneeze), as with other respiratory viruses. RSV usually leads to a mild illness with cold-like symptoms (e.g., runny nose, coughing). However, some groups are more likely to have severe illness or complications, including children younger than two years of age, older adults, individuals with heart or respiratory conditions, and immunocompromised individuals.
Ontario recently launched a targeted RSV prevention program for high risk individuals and settings. This includes individuals 60 years and older living in long-term care homes, including Elder Care Lodges and residents of retirement homes licensed to provide dementia care. Please speak with your health care provider if you have questions regarding eligibility.
To provide electronic consent for the RSV vaccine as a substitute decision maker, please complete the form using the link below:
COVID-19 Vaccines
It is recommended that residents of long-term care homes receive a spring booster dose if at least six months (168 days) has passed since their last dose or confirmed COVID-19 infection.
St. Joseph's Care Group provides COVID-19 vaccines and boosters for long-term care residents. To provide consent for yourself or as a substitute decision maker for someone else, please use the link below.
- COVID Vaccine Consent Form for Bethammi Nursing Home
- COVID Vaccine Consent Form for Hogarth Riverview Manor
To learn more about COVID-19 vaccines, please visit: Ontario Government - COVID-19 Vaccines
Influenza Vaccines
Seasonal influenza vaccine programs are one of the most important steps in protecting residents from contracting influenza. Seasonal influenza vaccine is tailored each year to what the World Health Organization anticipates will be the circulating strains of influenza in the general population in the coming year.
To provide electronic consent for the influenza vaccine as a substitute decision maker, please complete the form using the link below:
