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Seneca County, OH Tier 1C Scheduling List - Qualifying Medical Conditions, Pregnant Women, and Occupations
If you or your organization is in the State of Ohio Prioritization List, please complete this form to be placed on our vaccination scheduling list. As we receive more doses, we will work with you to inform you of the location, time and method of registration for you or your staff. At this time, we do not have exact dates and timeframes because it all hinges on when and how much vaccine we receive from the state. Once more information becomes available you will be notified so please be patient. Please do not submit your information more than once. You can view the priority list on this document:
https://coronavirus.ohio.gov/static/vaccine/general_fact_sheet.pdf
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Phase 1C: Ohioans with medical conditions & pregnant women: • Amyotrophic Later Sclerosis (ALS) • Bone Marrow Transplant Recipients • Type 1 Diabetes • Pregnant Women
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Yes, I confirm that I have one of the medical conditions listed above, and I am eligible to receive a vaccination as part of Ohio’s Phase 1B Vaccination Program.
No, I do not have one of these conditions, but am eligible due to my occupation.
Phase 1C: Occupation
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Child Care Services
Funeral Services
Law Enforcement & Corrections Officers (Police, Sheriff, State Highway Patrol, Special Jurisdiction Officers, Correctional Staff, Firefighters)
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Contact Name
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Your answer
Age
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Your answer
Number of People to Receive Vaccination
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Your answer
Contact Phone Number
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Your answer
Contact Email
Your answer
Address
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Agency/Organization Name
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