Covid Vaccine Request Form For Morbid Persons and Frontline Workers

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Download Covid Vaccine Booking Request Form For Morbid Persons & Frontline Workers @ covid19.kerala.gov.in

Covid Vaccination Booking Request Form in PDF to Download:- This is only a booking site to streamline the process of vaccination disbursement in Kerala. Citizens are requested to register in http://cowin.gov.in which is mandatory for the vaccination to be allotted. Only residents of Kerala will get approval for vaccination through the Covid 19 Vaccine booking portal. The information furnished if found bogus will be summarily rejected. This registration is meant only for Comorbid Personnel and Frontline Workers in the age group between 18 to 44 years. The morbidities and frontline workers can submit the Covid vaccine request form online @ covid19.kerala.gov.in.

Content

Steps to Vaccination Request Form submission for Co-morbid Persons
List of specified Comorbidities
Steps to Vaccine Request Form Submission for Frontline Workers
Frontline Workers Categories
Important PDF Files to Download

Steps to Vaccination Request Form submission for Co-morbid Persons

Persons who are registering for vaccination under Co-morbid Personal Request need to complete two steps. One is login and the second one is Request Submission. Follow the below-given steps to Apply for the request for Covid 19 Vaccination.

1.Login Process

Go to the vaccine registration portal by clicking here- https://covid19.kerala.gov.in/vaccine/
Select “Co-morbid Person”.
Enter your mobile number and click “Get OTP”.
An OTP will send to the mobile number. Enter the OTP in the box.
If the OTP is verified correctly, you will then be redirected to the vaccination request form.

2. Covid Vaccination Request Submission

The Covid Vaccine request form will display on the screen after login into the portal through mobile verification. Provide the following information and follow the steps to submit the request form.

Select your district.
Eligibility Group – Currently the vaccination request is only for persons with any
comorbidities in the age group of 18 to 44 years.
Your Name (as in ID Card)
Your Gender
Your Year of Birth – It shall be such that your age is between 18 years and 44 years.
Age Group
Select preferred vaccination centre → Based on vaccine availability the centre
might be changed and informed through SMS.
Upload Documents – Certificate to identify individuals with
co-morbidities that enhance the risk of mortality in COVID-19 disease for priority
vaccination. (To be filled by a registered medical practitioner)
Enter your COWIN Reference Number – You must register in COWIN Portal
(cowin.gov.in) to apply for vaccination. The COWIN reference number has to be
14 digits.
After filling up the form click SUBMIT button. A successful submission alert will be shown after submitting the form.

Download free the Covid Vaccine Request Form or Comorbid Certificate application form by clicking the below-given button.

Documents needed at Vaccination Center

At the vaccination centre, you shall submit the following documents for verification
1. Comorbidity Certificate
2. SMS received regarding vaccination schedule.
3. ID proof to verify age.

List of specified Comorbidities for determination of eligibility of citizens in the age group 18-44 years for priority vaccination

SL	Criterion
1	Diabetes Mellitus
2	Hypertension
3	All Cardiac Diseases (Congenital/Acute/Chronic)
4	All Lung Diseases including Asthma
5	All Neurological Conditions
6	Developmental Disorders
7	All Renal Diseases
8	All Liver Diseases
9	Inflammatory Bowel Disease
10	Any Cancer or on treatment for cancer
11	All Genetic disorders
12	Congenital Metabolic Disorders
13	Obesity- BMI >30 kg/m2
14	Endocrine Disorders
15	Rheumatological Disorders
16	Persons on Immunosuppressive therapy
17	Auto-Immune Diseases
18	Hematological conditions- Sickle Cell Disease/ Bone marrow failure/ Aplastic Anemia/ Thalassemia Major
19	Primary Immunodeficiency Diseases/ HIV infection
20	Poly Cystic Ovarian Disease (PCOD)
21	Differently-abled individuals
22	Any organ transplant -including Hematopoietic stem cell transplant: Recipient/On waitlist/Donor
23	Any other conditions which merit vaccination as per the certifying doctor.

Steps to Vaccine Request Form Submission for Frontline Workers

Employer or designated nodal officer (henceforth referred as Employer) of an organization in each district shall submit vaccination requests for frontline workers between 18 to 44 age group working under them. The request must be done district wise. COWIN registration is mandatory for submitting this request. COWIN reference number must be entered against each employee. District health authorities shall process the submitted request and once scheduled employee will get an SMS regarding vaccination date and venue details. The Employee can show received SMS and employee ID card at vaccination centre for verification.

Frontline Workers Login

Click on the given link to go to the home page – https://covid19.kerala.gov.in/vaccine/
Select the “FRONTLINE WORKER” option.
Enter the employer or nodal officer’s mobile number.
The OTP received in his mobile number has to be entered for verification.
If verified, and Employer not already registered, Employer Aadhaar number will be asked for Employer Authentication
Enter employer or nodal officer’s Aadhar number and verify received OTP.
If authenticated/verified the Employer has to register.
Select Employer district.
Select Employer organization type from the approved list.
Enter the organization name.
If the organization type is the government following details to be entered.
1. Employer Official ID card for upload
If the organization type is private following details to be entered.
1. LSGD license number
2. LSGD license document to be uploaded
Employer or nodal officer name as in Aadhaar will be shown in the form (uneditable)
Enter employer or nodal officer designation and employer number.
Click the “SUBMIT” button.
After successful employer registration, the Employee details input screen will be displayed.

Employee Details Submission For Vaccine Request

After completing the registration successfully, employer or nodal officer’s can upload employees details. Follow the below-given steps to add employees details and fill Covid vaccine request form.

Click on the “Add Employee” button.
Enter employee name, gender, year of birth, mobile number, preferred vaccination centre, COWIN registration number and click the “Add employee” button to enter the next employee.
Read the undertaking form and select the check box.
Reenter the employer or nodal officer Aadhar number and validate OTP.
Submit request.
The request will be sent to the selected district health department.

Directions to Employer

• Each organization can deploy as many responsible ‘Employers’ for easy and effective submission
of employees.
• Employers can submit multiple batches of the employee.
• It is the responsibility of the Employer (Government or Private) alone to ensure that the
employees submitted under his / her registration are as per the existing orders and guidelines
issued by Government from time to time.
• The Approver (Health Department) will be ensuring the authenticity of the Employer and will
approve the list of employees submitted by him/her.

Important Documents Need At Vaccination Center

At the vaccination centre employee shall submit the following documents for verification
1. SMS received regarding vaccination schedule.
2. ID proof to verify.
➢ Based on the verification spot registration will be done in COWIN and the vaccinator will
administer the vaccine.