Proof of COVID-19 Vaccine or Exemption

Proof of COVID-19 Vaccination or Exemption

Note: Before starting, be prepared to provide proof of either COVID-19 vaccination (first dose or complete series) or exemption.

Proof of COVID-19 vaccination: A copy of the COVID-19 vaccination card must be uploaded.

Proof of Medical Exemption: A recognized clinical reason for the contraindication is required, with a statement recommending exemption that is signed and dated by physician or advanced practice provider and states the specific vaccine that is contraindicated.

Proof of Religious Exemption: Written proof or a screen shot showing a religious exemption has been granted is required. Proof of the religious reason is not needed.

* First Name (Legal):

* Last Name:

* Date of Birth (mm/dd/yyyy):

* Email Address (IU Health address preferred if known):

IU Health Person Number (formerly Team Member ID if known):

* Design and construction project team?

Yes

* Please indicate the affiliated organization.

* Has the first dose or primary series of COVID-19 been received?

Yes

* Required Fields