Online Appointment Scheduling and Consent form for March 25, 2021

To register for the March 25 Richland County COVID-19, please click HERE

If you have an appointment scheduled for this Thursday, here is the consent form. COVID-19 Moderna Vaccination Consent Form

Please bring your completed consent form, insurance card(s) and proof of Illinois residency/employment at your scheduled time.

1st dose Moderna will be given Thursday, March 25 at the Olney City Park Community Building. Registration is open to individuals who live or work in Illinois and belong to one of the following categories:

Age 65 or older

Higher education staff, government workers and media

• Frontline essential worker (Below are examples of frontline workers within the eligible categories for Phase 1b)

First responders: Fire, law enforcement, 911 worker, security personnel, school officer

Education: K-12 teacher, school administrator, student support staff, student aide, day care worker and center-based child care provider, home visiting provider, early intervention therapists, Head Start/Early Head Start provider, Preschool for All providers

Food and agriculture: Processing plants, veterinary health, livestock services, animal care

Manufacturing: Industrial production of goods for distribution to retail, wholesale, or other manufacturers

Corrections worker and incarcerated individual: Correctional officer and staff, jail officer and staff, juvenile facility staff, a worker providing inperson support or services, incarcerated individuals

U. S. Postal Service workers

Public transit worker: Flight crew, bus driver, train conductor, taxi driver, para-transit driver, in-person support, ridesharing service driver

Grocery store worker: Bagger, cashier, stocker, pickup, customer service

Shelters and adult day care staff: Homeless shelter, women’s shelter, adult day/drop-in program, sheltered workshop

Priority 1b Plus Population

Description: Persons with specific health-complicating conditions or status.

• Eligible Conditions

o Obesity

o Diabetes

o Pulmonary Diseases

o Smoking

o Heart Conditions

o Chronic Kidney Disease

o Cancer

o Solid Organ Transplant

o Sickle Cell Disease

o Pregnancy

• Persons with a Disability