1. Video Areas

3. Persons arriving in the Video area will have their paperwork with them.
If they do not, have a supply of forms on hand in the Video Area
Staff will need to know where packet of forms are supplied.

4. Video Area will allow for:
persons to view the CDC Video
persons to complete all necessary paperwork
persons with certain conditions to be referred to the Medical Screening Area
the entire process to take minutes

5. CDC Video
Will be used to provide Smallpox Disease and Vaccine Information
FDA regulations require that persons view the video

6. Video Areas
Persons will arrive to the Video Areas with an Information Packet from the Forms Distribution Area.

7. Information Packet contains: (DRAFT ONLY)
Education materials on Smallpox Vaccine
Medical Screening Form
Vaccine Documentation Form
Instructions on How to Care for the Vaccination Site

8. Video Area Staff
Will refer non-English speaking persons to the Special Assistance Area for an Interpreter.
If a person is anxious, hostile, or disoriented, find Security for assistance.

9. Video Staff
Will need to be familiar with the TV/VCR operation and be able to rewind the tape.
Will direct people into each Video Session Area

10. Before starting the video
Staff will explain to the group the purpose of the video which is to provide Smallpox Disease/Vaccine Information.
The video will explain certain conditions that may prevent a person from receiving the vaccine

11. After viewing the Video
Staff will instruct the group to complete their paperwork and sign the Medical Screening and Consent Form.
Time is allowed for reading and completing the paperwork.

12. Video Area Staff
Will check each vaccine recipient’s form for completeness and accuracy.
Hand-out: Medical Screening and Consent Form
(Example only)

13. If a person has answered
Yes or Maybe to any of the conditions listed on the Medical Screening and Consent Form: Refer them to the Medical Screening and Consultation Area or they may choose to exit the clinic.
No to any of the conditions listed on the Medical Screening Form; direct them to the Vaccination Area with their forms

14. Signs may be posted directing persons to either the Medical Screening Area or the Vaccination Area.

15. If a person declines to be vaccinated, they may exit the clinic.