AUTHENTICATING VACCINATION STATUS FOR INDIVIDUALS SUBJECT TO THE ORDER 

Individuals subject to the Executive Order may prove their COVID-19 vaccination status by providing Northeast Medical Institute  a copy of any one of the following categories of documentation: 

1) A CDC Vaccination Card AND a declaration signed by the individual attesting to the authenticity  of the card. It is a crime under  federal law to use, buy, sell, or transfer a CDC vaccination card knowing that the card is fraudulent. A  violation of this federal law is punishable by a fine or imprisonment of up to five years. 18 U.S.C. SEC.  1017; or  

2) A record from the individual's vaccine provider indicating the type of vaccine and the date(s)  administered ("Provider Vaccination Record"). Individuals may contact their vaccination provider to  request a copy or log into the patient portal for that provider; or 

3) A certificate from the Vaccine Administration Management System ("VAMS"), if the individual  received vaccination through the V AMS system ("V AMS Certificate"). Individuals may log into V AMS; 

The Executive Order requires all individuals and facilities to obtain the appropriate immunization  documentation by the September 7th deadline. Processing delays with vaccine providers, VAMS, or DPH  will not excuse compliance with the Executive Order. 

***All Contracted staff MUST be vaccinated. Exemptions are not allowed***

CDC COVID-19 Vaccination Card Declaration  

Declaration Attesting to the Authenticity of an Individual's CDC  COVID-19 Vaccination Card  

Pursuant to Executive Order No. 13B, a long-term care facility shall ensure individuals with direct access  to a patient or resident of a long-term care facility are fully vaccinated against COVID-19, partially  vaccinated by September 7, 2021, or exempted from the vaccine requirement for medical or religious  reasons. Individuals submitting a CDC vaccination card to verify their vaccine status must also include a  declaration attesting that the card is authentic.  

I declare that the attached is a copy of the CDC vaccination card I received when I was vaccinated for  COVID-19 and that the information on the card is true. I understand that it is a crime under federal  law to use, buy, sell, or transfer a CDC vaccination card knowing that it's fraudulent. A violation  of this federal law is punishable by a fine or imprisonment of up to five years. 18 US. C. SEC  1017;