COVID-19 Vaccine Data Management
Documents and Forms
The following forms are meant for PRINT USE ONLY and were not designed for use as a digital medium. Please contact IHSSection508@ihs.gov for any questions about accessibility for these forms.
- COVID-19 Vaccination EMPLOYEE Record [PDF - 591 KB]
- COVID-19 Vaccination PATIENT Record for EHR [PDF - 577 KB]
- COVID-19 Vaccination PEDIATRIC Patient Record for EHR [PDF -595 KB]
- IHS-505 Disclosure Form [PDF - 8 KB]
- IHS-810 Authorization for Use or Disclosure of Protected Health Information [PDF]