Submit C-19 Vaccination Records

Acceptable documentation List

The following documentation is acceptable:

• A digital copy of the record of immunization from a health care provider or pharmacy.
• A copy of medical records from a medical provider documenting the vaccination.
• A digital copy of immunization records from a public health or state immunization information system. Please redact
  other vaccine or health information, if any, from that record.
• A digital vaccination record from CLEAR app.
• A copy of any other official documentation verifying vaccination with information on the vaccine name, date(s) of
  administration, and the name of health care professional or clinic site administering the vaccine.

PSI has elected NOT to accept a copy of Vaccine Record Card, CDC Form MLS-319813_r, because of irregularities and
difficulties in verifying the validity of those cards. Anyone submitting a CDC Card, will be asked to re-submit their
documentation using one of the five methods above.

No medical information other than the proof of vaccination should be sent and it will be held in confidence and treated as
a health record with limited access only on a need-to-know basis.

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