Unlike the health department, Casa Verde Pediatrics, Inc. is required to bill health insurance for COVID vaccine administration.
To ensure that we can send the claim seamlessly, we are collecting insurance information now.
The federal government asks us to collect a unique identifier -- either your Social Security number (SSN) or driver's license.
* I have completed this information completely and correctly to the best of my ability.
* I have had the opportunity to view the CDC Information on COVID-19 vaccines . I understand I will have the opportunity to ask questions prior to my vaccination.
* I have reviewed the Privacy Practices of Casa Verde Pediatrics, Inc.
* I have reviewed the Fact Sheet for COVID19 vaccine.
* I have reviewed the VSafe information.
*I have reviewed the VIS form from Mayo Clinic for the COVID-19 Vaccine.