This government document is issued by City of San Antonio for use in San Antonio, TX
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https://www.google.com/url?client=internal-element-cse&cx=013658287118846917901:1fbwneawkiu&q=https://www.sanantonio.gov/Portals/0/Files/health/HealthProfessionals/SAIRS/VaccineAdministrationConsentForm.pdf&sa=U&ved=2ahUKEwjUzb_bnpL0AhUyiP0HHV_rAGs4KBAWegQIBRAB&usg=AOvVaw2dmuAFCxYDC2uaK-cAKgXq