Vaccine Information Management System

Vaccine Information Management System
Online Registration - Adult

Category Required

Prioritization Required

Available ID Required

Enter ID No. Required Type NA for not applicable

Philhealth ID Required Type NA for not applicable

PWD ID Required Type NA for not applicable

Are you a Social Pension Grantee ? Required

Last Name Required

First Name Required

Full Middle Name Please avoid Middle Initial for inconsistencies Leave it blank if no middle name

Suffix Required Choose NA for not applicable

Date of Birth Required

Contact No. Required eg. 09123456789 - please follow this format

Residency Required

Residency Status

Complete Address Required

Home Address

Barangay Required

Sitio Required

Sex at birth Required

Civil Status Required

Employment Status Required

Profession Required

Providing direct care to a Covid-19 patient ? Required

Name of Employer Required Type NA for not applicable

Governmental Unit which the Employer Belongs Required Choose Cebu City for not applicable

Company Address Required Type NA for not applicable

Company Contact Number Required Type NA for not applicable

With Allergy ? Required

Choose Allergies

Drug

Food

Insect

Latex

Mold

Pet

Pollen

Vaccines or Component of Vaccine

With Comorbidities ? Required

Choose Comorbidities

Hypertension

Heart Disease

Kidney Disease

Diabetes mellitus

Bronchial Asthma

Immunodeficiency state

Cancer

Others

Covid history ? Required

Date of first positive result / specimen collection

Classification of Infection

Are you willing to be vaccinated ? Required

I hereby certify that the above information are true and correct to the best of my knowledge. I allow the Cebu City Vaccination Operation Center to collect and process my Personal Information and Sensitive Personal Information for the vaccination profiling purposes. The information herein shall be treated as confidential in compliance with the Data Privacy Act of 2012.

Vaccine Information Management System Online Registration - Adult

Vaccine Information Management System
Online Registration - Adult