Per NYSDOH guidance for group 1a,, the following persons are eligible to receive the vaccine beginning week 4:

Beginning Week 4, January 4, 2021:

  • All Outpatient/Ambulatory front-line, high-risk health care workers of any age who provide direct in-person patient care,or other staff in a position in which they have direct contact with patients (i.e., intake staff), will be eligible to receive COVID-19 vaccine. o This includes, but is not limited to, individuals who work in private medical practices; hospital-affiliated medical practices; public health clinics; specialty medical practices of all types; dental practices of all types; dialysis workers; diagnostic and treatment centers; occupational therapists; physical therapists; speech therapists; phlebotomists; behavioral health workers; and student health workers.
  • All front-line, high-risk public health workers who have direct contact with patients, including those conducting COVID-19 tests, those handling COVID-19 lab specimensand COVID-19 vaccinations, will be eligible to receive COVID-19 vaccine.
  • Home care workers and aides, hospice workers, personal care aides, and consumer-directed personal care workers.
  • Staff and residents of nursing homes, skilled nursing facilities, and adult care facilities.

Such persons are required to :

Vaccine Form

All individuals receiving the COVID-19 vaccination must fill out the NYS DOH COVID-19 Vaccine form pursuant to Executive Order 202.86 and attest that they are eligible to be vaccinated.

Proof of Occupation

Individuals being vaccinated who come from outside the facility must bring proof of eligibility to the vaccination site. This may include an employee ID card, a letter from an employer or affiliated organization, or a pay stub, depending on the specific priority status. Alternatively, employers or organizations can provide a list of staff who meet the criteria for vaccination. Do not vaccinate any person who does not have proof of their occupation or priority status. Executive Order 202.86 imposes monetary penalties for any provider vaccinating an individual who has not certified eligibility or for who the provider otherwise has knowledge the individual is not a member of a priority group.

The NYSDOH vaccine form includes a self-attestation regarding eligibility for vaccination, which must be completed prior to vaccination. Vaccination eligibility must be based on current employment status.