New Online COVID-19 Provider Vaccination Registration Form Open for Enrollment

December 3, 2020—If you plan to participate in administering COVID-19 vaccine once it is available, the Michigan Department of Health and Human Services Division of Immunizations' requires that you complete the online COVID-19 Provider Vaccination Registration Form. Click here for the registration form, sample forms, and FAQs. Physicians are also required to enroll in MCIR as a prerequisite to administer COVID-19 vaccine. Please note that if you are already enrolled to provide flu vaccine and intend to provide COVID-19 vaccine, you must also complete the new COVID-19 registration form.

Physicians administering the vaccine will be required to provide a COVID-19 vaccine record card to each patient / parent / legal guardian. These cards are important so patients know when their second vaccine dose is due. Physicians must also provide a product-specific EUA fact sheet to each vaccine recipient / parent / legal guardian prior to vaccination. Physicians are encouraged to urge patients to download and use the CDC’s V-safe smartphone-based tool for vaccine safety / symptom monitoring. This information will be delivered to CDC.

For up-to-date information, visit www.michigan.gov/COVIDvaccine. There you will find vaccine information for physicians, vaccination training programs, billing and coding, etc.

Michigan Department of Health and Human Services and the CDC will be hosting webinars and providing updated information regarding COVID-19 vaccines once they are approved, which is still anticipated to be as early as this month. It is important to remember that vaccines will be available to individuals on a tiered level. Information on priority groups and distribution plans are explained in the MDHHS Vaccination Plan.

Questions on registration can be sent to MDHHS-COVIDVaccineProviders@michigan.gov.