AKAUSIVIK INUIT FAMILY HEALTH TEAM
Consent Form for Covid 19 vaccination - COVaxON
Since the start of this pandemic, the Akausivik Inuit Family Health Team ("AIFHT") has kept our doors open - providing COVID-19 tests and early access to the COVID vaccine. At the same time, we have continued to offer treatment, medications, prescriptions, mental health supports, and outreach. www.aifht.ca.
We are honoured that so many of you have journeyed this far with us.
Our latest challenge is making sure you get the proof of vaccine that you need.
The receipts provided by AIFHT (hardcopy and PDF) are valid receipts. COVaxON is not required for proof of vaccination.
By checking the 'Yes' box below, you are asking AIFHT to share your COVID-19 vaccination status information with the Ontario Ministry of Health for the purposes of including it in COVaxON, the COVID-19 Vaccination Portal and/or the new Enhanced Vaccine Certificate with a QR Code system.
ONTARIO: COVaxON / COVID-19 Vaccination Portal / Enhanced Vaccine Certificate with a QR Code
COVaxON is Ontario's provincial system to record COVID-19 vaccinations.
The COVID-19 Vaccination Portal is used to download vaccination receipts from Ontario's provincial booking portal.
Your vaccination status information that will be shared with the Ministry of Health includes first and last name, gender, date of birth, health card # OR generated COVID ID, the lot #, date of vaccination, the place you received your first, second dose, and booster as well as where the dose was administered on your body
- The Ontario Ministry of Health may use your information for a variety of purposes. Enclosed the MOH Covax consent Form.
By checking 'Yes' below, you are asking AIFHT to provide your vaccination status information to the Ontario Ministry of Health for entry into the COVaxON, COVID-19 Vaccination Portal.
- Any information given to the Ontario Ministry of Health for entry into COVaxON/COVID-19 Vaccination Portal/Enhanced Vaccine Certificate with a QR Code system is owned and controlled by the ministry. It will be subject to the Ministry of Health's policies, practices and procedures regarding personal information.
- AIFHT is not responsible for any losses, expenses, costs, damages, liabilities, causes of actions, claims, lawsuits or other proceedings arising from providing your vaccination status information to the Ontario Ministry of Health.
- You cannot withdraw your consent once given.