COVID Vaccine Scheduling Form

 
 
 
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Ohioans born with or who have early childhood conditions that are carried into adulthood which put them at a higher risk for adverse outcomes due to COVID-19. 1. Sickle cell anemia. 2. Down syndrome. 3. Cystic fibrosis. 4. Muscular dystrophy. 5. Cerebral palsy. 5. Spina bifida. 6. People born with severe heart defects, requiring regular specialized medical care. 7. Diabetes, all types. 8. Phenylketonuria (PKU), Tay-Sachs, and other rare, inherited metabolic disorders. 9. Epilepsy with continuing seizures; hydrocephaly; microcephaly, and other severe neurological disorders. 10. Turner syndrome, fragile X syndrome, Prader-Willi syndrome, and other severe genetic disorders. 11. People with severe asthma, who have been hospitalized for this in the past year. 12. Alpha and beta thalassemia. 13. Solid organ transplant candidates and recipients. 14. Amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease. 15. Bone marrow transplant recipients. 16. Pregnant women. 17. End-stage renal disease https://coronavirus.ohio.gov/wps/portal/gov/covid-19/covid-19-vaccination-program
 
1. Child Care Services 2. Funeral Services 3. Law Enforcement Services including Corrections Officers 4. Firefighters *For details of how the Ohio Department of Health defines individuals eligible in these occupations select the link below. https://coronavirus.ohio.gov/wps/portal/gov/covid-19/covid-19-vaccination-program
 
 
 
 
 
 
Occasionally, Adena will have no-shows and cancellations for 1st dose COVID-19 vaccine appointments. In an effort to not waste any vaccine provided to Adena by the Ohio Department of Health, we are establishing an on-call list of patients who could arrive quickly to receive their vaccination. If you are contacted to fill one of these open appointment times you are agreeing to arrive at Adena’s PACCAR Medical Education Center within 30 minutes from being called between the hours of 4-5 p.m. Wednesday through Friday. There are typically between 10-20 of these type of appointment slots available during Adena’s 1st dose vaccine clinic days.