Pa Pharmacy Covid 1c Screening
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PA Pharmacy COVID 1c Screening
Use for pre screening of Phase 1c COVID vaccine
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Please answer the following questions to determine if you are eligible for the COVID-19 vaccine.
Description:Screening form for Phase 1c COVID vaccine
This form is designed to pre-screen individuals for Phase 1c COVID vaccine eligibility. The form includes questions about age, occupation, and underlying medical conditions. By completing this form, individuals can determine if they are eligible for the vaccine and can schedule an appointment for vaccination. This form is intended for use by pharmacies administering the vaccine to Phase 1c individuals.
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