CDC & NYS COVID-19 Vaccination Forms, Documents, Checklists

NYS COVID-19 Vaccination Handbook

• NYS COVID-19 Vaccination Program Handbook (10/16/2020)

Provider Enrollment and Support

• NYC DOHMH COVID-19 Vaccination Enrollment Letter
• NYS COVID-19 Vaccine Provider Profile Addendum
• CDC COVID-19 Vaccination Program Provider Agreement
• CDC Supplemental COVID-19 Vaccine Redistribution Agreement
• Guidance on COVID19 Screening Checklist
• Ordering COVID-19 vaccine in the New York State Immunization Information System
• Vaccine hospital ordering letter

COVID-19 Vaccination Clinic Forms and Resources

• NYS Pre-Screening Vaccine Form
• NYS Am I Eligible (link)
• NYS COVID-19 Vaccination Form
• Screening Checklist for the COVID-19 Vaccine
• NYSDOH COVID-19 Vaccine Tracker
• V-Safe (CDC's after vaccination Health Checker)
• Immunization Screening and Consent Form (optional)
• Moderna and Pfizer guidance and forms
• Moderna standing order
• Pfizer standing order