Vaccinating Non-UPMC Health Care Workers in PA
Vaccinating Non-UPMC Health Care Workers in PA

Vaccinating Non-UPMC Health Care Workers in PA

On December 30, 2020, the Pennsylvania Department of Health issued an order to ensure that community health providers are being vaccinated during Phase 1A. This order requires that hospitals, health systems, Federally Qualified Health Centers (FQHCs), and pharmacies reserve at least 10% of each shipment of vaccine to vaccinate health care personnel not affiliated with a hospital or health system.

UPMC is committed to making vaccine available to frontline health care workers of all types in the communities we serve.

This request process is ONLY for health care workers in phase 1A who are not affiliated with a hospital or health system, and cannot process other requests.

Request Covid-19 Vaccination from UPMC

If your organization would like to request vaccination from UPMC, please complete the following form, and all requested information about those for whom you are requesting vaccination. Once submitted, you will receive an email confirmation with additional details.

Important Notes About Making Your Request

  • Requests for vaccination should be made at the organizational level, not by each individual within an organization.
  • Please complete the form and attachment only once for your organization.
  • If you contacted UPMC leadership about vaccination, please complete and submit the form and attachment.
  • Please follow all instructions for completing the request.
  • If you are the only member of your practice, or are not affiliated with any organization, you can still submit a request, but must also complete and submit the attachment.
    • If you are submitting as a single request and do not have a Tax ID, please use your driver’s license number where Tax ID is requested.
  • We are not currently accepting requests for vaccination for individuals under the age of 18.

Instructions for Completing and Submitting Your Request

  • Download the Community Health Care Vaccine Request Excel template.
  • Complete the information in the template for each person you are requesting be vaccinated.
    • You will need to have each individual's email address and cell phone in your attachment.
      • You cannot use the same email and cell phone for multiple people or we will not be able to contact them directly in order to collect essential information and schedule.
    • You will also need each individual's date of birth.
    • Each person you list will need to be assigned a color grouping. Use the color grouping chart to assign a grouping for each individual in your file. Every individual must have a color grouping.
      • The defining difference between the Purple and Blue group is whether or not the primary office location is in a federally-designated medically underserved area/population.
      • You can find this information by entering the primary office address into the Health Resources & Administration tool.
    • Please refrain from using or writing “ditto” in any form field. All information needs to be fully filled out for each individual.
    • If you do not complete the yes/no sections for age or underlying health conditions, we will not be able to offer additional prioritization for individuals based on those criteria
      • You do not need to ask about or enter specific conditions, employees can just self-identify as having one or more, based on the CDC guidelines.
  • If you are requesting only one vaccine for yourself, you must still fill out the Excel template document.
  • Save the document as: Vaccine Request_Your Organization Name_Tax ID
  • As the representative making this request, please enter the requested information into the form below.
  • Once you’ve entered the information, attach your saved document to your form submission below – you will not be able to submit your request without the attachment.

Submission of this form does not constitute an agreement or reservation for vaccine as the information will be evaluated by UPMC for validation of 1A status. Upon validation, UPMC will provide further information on the scheduling process.