Menu
Appointments MyChart ER Wait Times
Search
Back

Orlando Health's COVID-19 Vaccine Program - Medical Education

Medical Education COVID-19 Vaccinations

Medical Education COVID-19 Vaccinations

Orlando Health is required to maintain certain COVID-19 vaccine information for all members of medical education who perform duties at any Orlando Health facility that provides services to patients.

 

Please provide the following information: *

 

Name: *

Email: *

Phone Number: *

Dictation ID:

Please indicate ONE of the two options listed below and complete the attestation.

 

Option 1: Document a complete COVID-19 vaccination series. A complete vaccination series is receiving two doses of the Pfizer or Moderna vaccine or the single-dose J&J/Janssen vaccine.

 

  • Date of Dose 1:

    Date of Dose 2:

  • Date of Dose 1:

    Date of Dose 2:

  • Date of Dose 1:

Option 2: Document an exemption from the COVID-19 vaccination.

 

Attestation: *