The following questions will help determine if there is any reason you should not receive a COVID immunization injection. Answering "yes" to any question does not prevent you from being vaccinated. It means additional questions will be asked. If a question is not clear, please ask a healthcare provider to explain.
Has the person to be vaccinated ever received a COVID-19 vaccine? If Yes please contact the pharmacy to cancel your appointment as we do not have second doses of Pfizer or Moderna available. We are only administering JANSSEN COVID vaccinations at this time.
Massachusetts law (M.G.L. c. 111, Section 24M) requires providers to reportimmunization information to a computerized immunization registry known as theMassachusetts Immunization Information System (MIIS). The MIIS stores immunization records for you and your healthcare provider and can help prevent outbreaks of disease like measles and the flu. All information in the MIIS is kept secure and confidential. The MIIS allows information to be shared with health care providers, school nurses, local boards of health, and state agencies concerned with immunization. You have the right to object to the sharing of your immunization information across providers in the MIIS.For more information, please ask your healthcare provider, visit the MIIS website atwww.mass.gov/dph/miis or contact the Massachusetts Immunization Program MIIS Help Desk directly at 617-983-4335.
Vaccine manufacturer Janssen (J&J)
The above information is true to the best of my knowledge. If qualified, I authorize billing to my insurance company and release of information required to process my claims.