Page 509 - eBook Version 8 Book 1 of 2 JUL 2022

COVID-19 Vaccination Requirement
Date: ______________
Children’s HealthSM
1935 Medical District Drive Dallas, TX 75235
The following individual has met Children’s Health COVID-19 vaccination requirements as outlined below:
Name: ______________
Company: _____________
Assigned Children’s Department: Research Administration
Effective Friday, Oct. 1, Children’s Health is requiring all team members, practitioners, volunteers, students/trainees, vendors and contractors to receive the COVID-19 vaccine and be fully vaccinated to be allowed onsite.
Similar to our flu vaccine protocol, the COVID-19 vaccine is required as a condition of employment or a condition of delivering care and support to the patients we serve.
Here is what you need to know:
• Individuals will be considered “fully vaccinated” when they have received both doses of either the Moderna or Pfizer vaccine or the one-dose Johnson & Johnson vaccine.
• Non-Employees who are 100% remote (never onsite) are excluded from this requirement.
• Individuals will be prohibited from onsite visits at Children’s Health facilities if they are not fully vaccinated.
I understand that I may be asked to provide the actual documents I am attesting to in this letter during an audit or a survey.
I agree to notify Children’s Health within 24 hours if my compliance status changes and a new attestation letter will be required for updated information or extension of time.
Signature: __________________________ Date: __________________