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VIRGINIA DEPARTMENT OF BEHAVIORAL HEALTH AND DEVELOPMENTAL SERVICES COVID-19 VACCINE PRESCREENING ELIGIBILITY FORM FOR THE MODERNA VACCINE1Name: DOB/Age: Medical record number (if applicable): For

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How to fill out covid-19 vaccine pre-screening eligibility

01

Step 1: Begin by downloading the covid-19 vaccine pre-screening eligibility form from the official healthcare department website.

02

Step 2: Carefully read and understand the instructions mentioned on the form.

03

Step 3: Fill in your personal details such as name, age, contact information, and address in the designated fields.

04

Step 4: Answer the pre-screening questions honestly and provide accurate information about any pre-existing conditions or previous vaccinations.

05

Step 5: Ensure you have all the necessary documents and medical records required to support your eligibility, such as a doctor's prescription or relevant medical reports.

06

Step 6: Double-check the form to ensure you have filled in all the required fields correctly.

07

Step 7: Submit the completed form either online through the designated portal or physically at the healthcare department.

08

Step 8: Wait for the healthcare department to review your eligibility and notify you about the next steps to take.

Who needs covid-19 vaccine pre-screening eligibility?

01

Anyone who is planning to receive the covid-19 vaccine needs to fill out the pre-screening eligibility form.

02

It is especially important for individuals with underlying health conditions or those who fall under high-risk categories to complete the form.

03

By filling out the form, healthcare professionals can assess the individual's eligibility and determine if any additional precautions or medical considerations are necessary.

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What is covid-19 vaccine pre-screening eligibility?

COVID-19 vaccine pre-screening eligibility refers to a process that determines if individuals meet certain criteria to receive the vaccine, including age, health conditions, and potential allergies.

Who is required to file covid-19 vaccine pre-screening eligibility?

Individuals seeking to receive the COVID-19 vaccine may be required to complete pre-screening eligibility forms to ensure they meet the necessary criteria.

How to fill out covid-19 vaccine pre-screening eligibility?

To fill out the COVID-19 vaccine pre-screening eligibility, individuals typically need to provide personal information, health history, and answer specific questions related to allergies or previous vaccine reactions.

What is the purpose of covid-19 vaccine pre-screening eligibility?

The purpose of COVID-19 vaccine pre-screening eligibility is to assess the safety and suitability of the vaccine for individuals, minimizing risks and ensuring effective vaccination.

What information must be reported on covid-19 vaccine pre-screening eligibility?

Information that must be reported includes personal details such as name, contact information, health conditions, vaccination history, and any known allergies.

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