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Saturday, January 9, 2021
Division of Emergency Management Contracts with CDR Health to Provide Vaccines Beginning Monday -- New Consent Forms and Instructions Below

CDR is forwarding the following information to facilities as they make initial contact and schedule their appointment day. 

Please note, CDR Health understands that you are going to be getting a lot of feedback about what a heavy lift this is for some of the facilities (especially those without electronic medical records) in a very short period of time. 

As discussed, we have been tasked by the state to visit 100% of the remaining facilities that CVS/Walgreens hasn’t visited by January 23rd before the end of the month. They ask for patience and understanding as they work expeditiously to complete that mission. Items to note:

  • CDR Health is vaccinating both patients and employees in case that wasn’t clear in the attached.
  • CDR Health is asking facilities to get as much of the attached information on the spreadsheet as possible. Even just name, date of birth, address, phone, insurance will help speed up the process day of. (For patients we will default to facility’s address so we just need addresses for employees).
  • CDR Health will have the ability to register individuals on site and if they are able to provide their own consent then we can register and vaccinate onsite. That will drastically slow up the process while there, so we are asking for helping collecting as much of the information in advance as possible given the short notice.
  • CDR Health is only asking for facilities to indicate on the attached spreadsheet how they received consent to vaccinate, whether it was from the patient, the healthcare surrogate, or other authorized individual. Our providers will also accept informed consent on site if the patients are able to give it.
  • For any patients who we could not register and/or consents could not be acquired, the facility will have time to get that information in between our 1st visit and 2nd visit so we can provide those particular patients their 1st shot during our second visit. 
  • CDR Health will visit the facilities 3 times to complete two rounds of doses.
Copy of CDR Health's Email Sent to ALF Administrators

Dear Mr./Ms. [LAST NAME]:

CDR Health is working with the Department of Health and the State of Florida to vaccinate the residents and employees of Long Term Care Facilities throughout Florida. The Agency for Health Care Administration (AHCA) issued a press release confirming that CDR Health would be providing vaccinations for your facility.

WE WILL BE VISITING YOUR FACILITY ON [VACCINATION DATE] BETWEEN THE HOURS OF [TIME SLOT] TO VACCINATE YOUR RESIDENTS. Please be aware, you do not have the ability to reschedule your vaccination date.

We request that you complete and return the ALF Patient Import Spreadsheet, attached to this email, at least 24 hours prior to your scheduled appointment date. Most facilities with an electronic health record system should be able to download a line list of the majority of this patient information rather easily. Failure to return the requested information will cause a significant delay on the day of your scheduled appointment. To help you properly complete the LTC Patient Import Spreadsheet, we have a included the LTC Patient Important Template Instructional Guide. This guide includes step by step instructions on how to properly complete the LTC Patient Import Spreadsheet.

Please note that the following questions in LTC Patient Import Spreadsheet must be answered based on the information in the patient’s medical record or as provided by the patient or the patient’s authorized representative.

  • Do you have a history of allergic reaction (i.e. anaphylaxis) to the COVID-19 vaccine?
  • Do you have a history of severe allergic reactions (i.e., anaphylaxis) to other vaccines or other injectable medication (not including the COVID-19 vaccine)?
  • Do you have a moderate or acute illness?
  • Are you allergic to iodine?
  • Are you allergic to peanuts or nut products?
  • Are you pregnant or plan to become pregnant?
  • Are you breastfeeding?
  • Do you have a bleeding disorder or are you on a blood thinner?
  • Are you immunocompromised or on a medicine that affects the immune system?
  •  Do you carry an Epi-pen for emergency treatment of anaphylaxis?
  • Have you received other vaccines in the previous 14 days?

On the day of our visit, we will ask all individuals being vaccinated to acknowledge their understanding of certain policies, including,

  1. The Emergency Use Authorization (EUA) of the Pfizer-BioNTECH COVID-19 Vaccine Fact Sheet,
  2. The CDR Health Privacy Policy,
  3. The HIPAA Privacy Notice,
  4. The CDR Consent to Contact,
  5. The Florida Department of Health Notice of Privacy Practices, and
  6. The Authorized Provider Acknowledgement. Before our visit, you must provide reasonable access to the foregoing documents to all individuals being vaccinated to allow them time to review and understand the documents. As such, we have attached a PDF for you to distribute to all individuals that will be receiving a vaccine. If you have any issues accessing this document, please reply to this email and we will happily send the forms in a different format.

It is important that you instruct all individuals that will be vaccinated that they must inform us of any changes that will affect the answers to the questions in the ALF Patient Import Spreadsheet by emailing

If between the date of submission of the ALF Patient Import Spreadsheet, and the day of our visit, we do not receive notice by email of changes, we will assume all answers in the ALF Patient Import Spreadsheet are true and correct.

Thank you for aiding in the effort to protect Florida’s most vulnerable citizens!
Should you have any questions or concerns, please feel free to contact us and a member of our team will be happy to assist you.