COVID-19 Vaccine Screening and Immunization Documentation

OMB 0720-0068

OMB 0720-0068

The Defense Health Agency (DHA) has created the DHA Form 207, “COVID-19 Vaccine Screening and Immunization Documentation” to determine if the COVID-19 vaccine can be administered to a patient. The DHA Form 207 will be used to determine and document patient eligibility and vaccine declinations for a COVID-19 vaccination. Respondents include Active Duty military members, Federal employees, beneficiaries, and contractors (based on their employment) who wish to receive the vaccine.

The latest form for COVID-19 Vaccine Screening and Immunization Documentation expires 2021-07-31 and can be found here.


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