Required Vaccination Forms
Mercer Health is required to meet CMS reporting guidelines for all employees, providers, students, and affiliated contract employers that work within our facilities. This includes vaccination status for COVID-19 prior to entering the facility and Influenza annually during the flu season (October through March).
Please call our Employee Health office at 419-678-7126 if you have any questions.
Covid-19 Vaccine Assessment Form
The Centers for Disease Control and Prevention recommends the Covid-19 vaccine for everyone over 5 years of age. CMS requires Mercer Health to report healthcare workers vaccination status for Covid-19.
Complete the Covid-19 Vaccination FormInfluenza Vaccine Assessment Form
The Centers for Disease Control and Prevention recommends the influenza vaccine (flu shot) for everyone over 6 months of age, including healthcare workers. Mercer Health is required to report the number of adult students practicing within the facility that received the vaccination or filed an exemption from receiving the current influenza vaccine. The reporting period for influenza vaccine is from October 1 to March 31 each year.
Complete the Flu Vaccination Form